developing food-based dietary guidelinesdeveloping food-based dietary guidelines a manual from the...

Developing Food-based

DietaryGuidelines

A manual from the English-speaking

Caribbean

Food-based dietary guidelines (FBDGs) provide practical advice

about ways to improve diets and health in a manner that is easy

for the public to understand. This manual explains a 10-step

process for developing FBDGs that can be used in most countries.

By following this process, nutritionists and others can create

FBDGs that are well-adapted to national needs and based on

nutrition science and communication expertise. A

multidisciplinary approach enables governments to assess the

country’s nutrition problems and to set realistic priorities for

improving diets. Technical recommendations are transformed into

simple messages the average person can follow. Nutritionists

learn to develop strategies for communicating dietary

information to the public. This manual is based on the

experiences of four Caribbean countries in developing national

FBDGs to promote healthy diets and to prevent obesity, diabetes

and cardiovascular diseases.

caribbean copertina ok 20-12-2007 6:41 Pagina 1

A Manual from the English-speaking Caribbean

Developing Food-basedDietary Guidelines

Food and Agriculture Organization of the United Nations

2007

impaginato dicembre07 20-12-2007 6:39 Pagina 1

i

Table of contents

Foreword

Part One:Reasons for developing Food-based Dietary Guidelines (FBDGs)1. Political commitment to improving nutrition2. Purpose and definition of FBDGs3. Rationale for FBDGs in the Caribbean

Part Two: Process of developing Food-based Dietary Guidelines (FBDGs) IntroductionStep 1: Planning and organizing the workStep 2: Characterizing the target groupStep 3: Setting the objectives for the FBDGsStep 4: Preparing the technical guidelinesStep 5: Testing the feasibility of the recommendations

and developing the pictorial food guideStep 6: Finalizing the FBDGs Step 7: Validating the FBDGsStep 8: Correcting and adjusting the FBDGs Step 9: Implementing the FBDGsFinal result: FBDGs postersStep 10: Evaluation of the FBDGs

Afterword

References

Annex 1: Testing recommendations for feasibilityAnnex 2: Behavioural trialAnnex 3: Choosing the pictorial diagram Annex 4: Draft communication strategy

v

135

151620262839

485253545963

65

67

69707476

impaginato dicembre07 20-12-2007 6:39 Pagina i

ii

List of Boxes

Box 1 FBDGs around the worldBox 2 Membership of the Grenada National FBDGs Task ForceBox 3 Contents of the situation analysis documentBox 4 Categorization of major problemsBox 5 Food groups that should be used in the FBDGsBox 6 Reasons for behavioural trialsBox 7 Household trial methodology used in St. VincentBox 8 Testing a recommendation in St. Vincent and the GrenadinesBox 9 Tips and motivational messagesBox 10 Advice for writing messagesBox 11 Places and events where FBDGs can be disseminatedBox 12 Media for disseminating FBDGsBox 13 Outlines for bookletsBox 14 Suggested activities in support of the national launch

impaginato dicembre07 20-12-2007 6:39 Pagina ii

iii

List of tables

Table 1 Problems identified by multi-sectoral groups in St. Lucia, Grenada, St.Vincent and the Grenadines and Dominica

Table 2 Decision matrix for prioritization of food and nutrition problems in St.Lucia and St. Vincent and the Grenadines

Table 3 Prioritized problems and objectives of nutrition guidelinesTable 4 Population groups covered by the three established energy requirement

levelsTable 5 Population framework nutrient goals Table 6 Summary of portions from different food groups needed for the three

energy requirement levelsTable 7 Formulation and analysis of the technical recommendations for FBDGsTable 8 Summary of technical recommendations for FBDGsTable 9 Preliminary technical recommendationsTable 10 Comparison of problems, objectives and technical recommendations Table 11 Draft FBDGs recommendations from Dominica, Grenada, St. Lucia and

St. Vincent and the Grenadines

List of figures

Figure 1 Trends in adult overweight/obesity in the CaribbeanFigure 2 Trends in young child (0-5 years) obesity in the CaribbeanFigure 3 Testing the feasibility of the recommendations Figure 4 TimetableFigure 5 Proportionality in a food graphic

impaginato dicembre07 20-12-2007 6:39 Pagina iii

v

Foreword

A fundamental goal of the Food and Agriculture Organization of the UnitedNations (FAO) is assisting the countries of the Caribbean in developing nationalstrategies, methods and tools to improve diets. Food-based dietary guidelines(FBDGs) are a key source of information that governments can use for educatingthe public on ways to do this. Using language and symbols that the average personunderstands, FBDGs provide relevant dietary advice for preventing common diet-related health and nutrition problems.

This manual’s aim is to offer practical advice to nutritionists and others working inrelated fields for producing national FBDGs for the general public. It explains therationale behind national FBDGs and outlines the steps needed for producingFBDGs. It also gives advice on ways to communicate this information to thepublic.

This manual is one result of a FAO technical cooperation project (TCP) for capacitybuilding in nutrition education.1 The project was conducted by FAO’s Sub-RegionalOffice for Latin America and the Caribbean and Nutrition and Consumer ProtectionDivision in collaboration with the Caribbean Food and Nutrition Institute (referredto as CFNI) and the Institute of Nutrition of Central America and Panama (referredto as INCAP), both institutions of the Pan American Health Organization (PAHO).The TCP was initiated at the request of the governments of the Commonwealth ofDominica, Grenada, Saint Lucia, and Saint Vincent and the Grenadines, and thework was carried out during the period September 2004–June 2007.

The general approach to developing FBDGs described in this manual waselaborated by FAO and the World Health Organization in 1995. The specificmethods to be used in each step in the process that are described in this manualwere first developed by INCAP. These have been applied and adapted for use inCaribbean countries by CFNI and FAO. FAO collaborated with experts from bothPAHO institutions in carrying out the project.

1 “Capacity building for the development of food-based dietary guidelines to promote healthy dietsand lifestyles” , TCP/RLA/ 3002 (A).

impaginato dicembre07 20-12-2007 6:39 Pagina v

vi Developing Food-based Dietary Guidelines

FAO would like to express its appreciation to the primary authors of this manual,Pauline Samuda and Verónika Molina, who also served as technical advisors andtrainers for the project. Based on their experiences as national coordinators for theproject to develop their national FBDGs, four nutritionists – Theresa MariettaRegis (Ministry of Health and Environment, Saint Vincent and the Grenadines),Betty Finlay (Grenada Food and Nutrition Council, Grenada), Jacqueline LancasterPrevost (Ministry of Health and Social Security, Dominica) and Merlyn Severin(Ministry of Health, Saint Lucia) – provided valuable suggestions and insights forthe manual. FAO would also like to thank Christa de Valverde, who served as aconsultant for the methodology on field testing of the FBDGs and Maria Protz, whoacted as a consultant for developing communication strategies.

Carmen Dardano, Nutrition Officer in the FAO Sub-Regional Office for LatinAmerica and the Caribbean in Barbados, had primary responsibility forcoordinating and providing technical support in the project and contributed to thismanual. Ellen Muehlhoff, Senior Officer, FAO Nutrition and Consumer ProtectionDivision, formulated the TCP in collaboration with Carmen Dardano and PaulineSamuda. Janice Albert, Nutrition Officer, FAO Nutrition and Consumer ProtectionDivision provided technical backstopping for the project, co-authored this manualand oversaw its production. Peter Glasauer provided valuable comments about themanual. Bernhard Reufels, Harripaul Bridgemohan, Melinda Mills and JoannaLyons of FAO provided invaluable assistance in the administration of the project.

We hope that the information provided in this manual and the knowledge and skillsthat are obtained through following the steps of developing FBDGs will strengthenefforts to improve nutrition and health among people in the English-speakingCaribbean today and in the future.

Barbara GrahamFAO Sub-Regional Representative for the Caribbean

impaginato dicembre07 20-12-2007 6:39 Pagina vi

Part one: Reasons for developing Food-Based

Dietary Guidelines

impaginato dicembre07 20-12-2007 6:39 Pagina vii

1

The United Nations (UN) and governments worldwide have declared that allpeople have the right to a nutritionally adequate diet at all times. The FBDGs are atool for helping countries to achieve this goal. FAO and the World HealthOrganization (WHO) have promoted the concept of FBDGs since the InternationalConference on Nutrition (ICN) in 1992 (FAO/WHO, 1992), when the “WorldDeclaration and Plan of Action for Nutrition” called upon governments to promoteappropriate diets and healthy lifestyles. At the World Food Summit, held at FAOHeadquarters in 1996, 180 countries approved the “Rome Declaration on WorldFood Security” in which the heads of state pledged that:

We will implement policies aimed at eradicating poverty and inequality andimproving physical and economic access by all, at all times, to sufficient,nutritionally adequate and safe food and its effective utilization. (FAO 1996,emphasis added) (FAO, 1996)

At the Millennium Summit in 2000, governments established the MillenniumDevelopment Goals (MDGs) (UN, 2006). Three of these goals are related directlyto improving nutrition:

• “Eradication of poverty and hunger.”• “Achieve universal primary education.”• “Reduce child mortality.”

Improved nutrition education can help to reduce malnutrition and hunger. It canenhance nutritional knowledge, attitudes and behaviours, social and dietarycustoms, family/childcare and feeding practices, and household hygiene. Betternutrition can improve educational achievements and reduce child mortality.

1. Political commitmentto improving nutrition


2 Developing Food-based Dietary Guidelines

FBDGs: Tools for achieving nutrition goals

In 1995 FAO and WHO sponsored an Expert Consultation on the Preparation andUse of Food-Based Dietary Guidelines in Cyprus (WHO, 1996). This group ofexperts reviewed experiences and elaborated a process for developing FBDGs.Following the recommendations of this international meeting, PAHO and INCAPpromoted the development and implementation of FBDGs through the:development of a methodology to elaborate FBDGs; organization of five sub-regional workshops with the participation of all Latin American countries; andprovision of technical assistance when needed.

In April 1999 the “Development of Food-Based Dietary Guidelines and NutritionEducation for the Caribbean” workshop was held in Bridgetown, Barbados. Jointlyorganized by FAO and the International Life Sciences Institute (ILSI International)in collaboration with the Caribbean Food and Nutrition Institute (CFNI), theworkshop was organized for countries of the English-speaking Caribbean. Itsobjective was to assist participating countries in developing and implementingFBDGs and to strengthen their capacity to communicate effective nutritioninformation to the public, in order to bring about lasting improvements in foodconsumption patterns and nutritional well-being. The Barbados workshop was oneof 17 regional workshops held by FAO, involving nearly 100 countries worldwide.

National food and nutrition policies and plans in the Caribbean

Following the ICN, National Plans of Action for Nutrition (NPAN) have beendeveloped by governments in the Caribbean in an effort to improve the nutritionalsituation of their populations. Each country’s NPAN is based on the country’snational development plans and is structured around the eight thematic areasidentified in the ICN Plan of Action. “Promoting appropriate diets and healthylifestyles” is included in the plans of all eastern Caribbean countries. Strategies forconsideration include:

• promoting better eating habits (e.g. dietary guidelines, variety of foods);• preventing lifestyle diseases; • promoting regular exercise; and • providing nutrition education.

The NPAN for each country is developed by a multi-sectoral group consisting of awide range of government ministries – such as agriculture, health, planning, trade,industry, social services, education, industry, sport, consumer affairs – as well ascooperation from academia, food processors, non-governmental organizations(NGOs), marketing and distribution sectors. The development of national FBDGs isa major activity emanating from the national plan of action.


3

The purpose of FBDGss is to assist the general population in following nutritionand related-health recommendations. FBDGs are a tool for nutrition education andbehaviour change to be used by health providers, teachers, journalists, extensionagents and others working directly with the public. The FBDGs presentinformation that uses language and symbols that the public can easily understand.FBDGs focus on common foods, portion sizes, and behaviours.

While different countries may share similar trends in dietary patterns, FAO andPAHO consider it important that, whenever possible, each country shoulddevelop its own set of guidelines. This is because large variations in foodavailability and accessibility, in food patterns as well as differences in lifestyles,cultures and public health priorities can exist between countries. AlthoughFBDGs may appear similar, they have been developed to meet the specific needsof a nation’s population and to suit the cultural, social and economic contexts.Food graphics or pictorial diagrams associated with FBDGs are indigenous forthe population of each country and may become important symbols in a nation’snutrition communication and education strategy.

FBDGs: Global patterns

Throughout the world, several characteristics are commonly found in dietaryguidelines – for instance, FBDGs always stress the importance of variety andbalance. It is also very common for FBDGs to promote increased fruit andvegetable consumption since daily consumption of fruit and vegetables addsvitamins and fibre to the diet and could help prevent obesity, diabetes,cardiovascular diseases and certain cancers. FBDGs often include advicediscouraging excessive consumption of saturated fats, salt, sugar and alcohol. Inaddition, with increasing attention to sedentary lifestyles, guidelines concerningthe importance of physical activity are more frequent. Information relating tofood safety can also be found in FBDGs because of concern about food-bornediseases.

There are also important differences between FBDGs. This is not surprising asFBDGs are determined by the specific health, behaviour, culture and economic

2. Purpose and definition of FBDGs



conditions within a country. For example, advice about dietary fats andcarbohydrates can vary greatly, depending on each country’s nutritional problems.While providing one set of guidelines for an entire nation is challenging, even verylarge countries with extremely diverse populations have decided to have one set ofFBDGs for the adult population. For infants and small children, some countrieshave created separate dietary guidelines, while others have incorporated advice forthese groups in their general guidelines.

Europe

Dietary guidelines are found in the Czech Republic, Denmark, France, Germany,

Greece, Hungary, Ireland, Italy, Latvia, the Netherlands, Slovenia, Spain, the United

Kingdom and Turkey. It addition, the European Union has developed the “Euro

diet” and WHO has promoted the “CINDI guidelines” (Countrywide Integrated

Non-communicable Diseases Intervention) for Europeans.

The Americas

In the Americas, Canada, Mexico, the United States of America and Venezuela were

among the first countries to publish FBDGs. Argentina, Barbados, Brazil, Chile,

Colombia, the Commonwealth of the Bahamas, Costa Rica, Cuba, El Salvador,

Guatemala, Guyana, Honduras, Panama and Uruguay have FBDGs.

Asia

In Asia and the Pacific, China, Indonesia, India, Japan, Malaysia, Nepal, New

Zealand, the Philippines, Singapore and Thailand have developed FBDGs. In

addition, there are WHO regional guidelines for the Western Pacific Islands.

Africa

Among African countries, Namibia, Nigeria, and South Africa have published

FBDGs.

Near East

In the Near East, Iran has developed FBDGs and Lebanon and Egypt also have food

guides.

Box 1: FBDGs around the world


5

Health and Nutrition Situation

Epidemiological profileSince the 1980s an epidemiological transition has taken place across theCaribbean region. This transition has manifested itself in a decrease in infectiousdiseases and an increase in chronic non-communicable diseases (NCDs). Infantand child mortality have decreased precipitously with improvements in access topre-natal care, nutrition, sanitation, immunization, and oral rehydration therapy.Between 1980 and 1995, communicable-disease mortality rates in children aged1–14 years declined by 67 percent (WHO, 2001). For the year 2000, infantmortality rates (deaths per 1 000 live births) for Grenada, Saint Lucia, Dominica,and Saint Vincent and the Grenadines were 12.5; 13.4; 17.5 and 22.0, respectively(PAHO, 2002).

Most eastern Caribbean countries experienced similar crude death rates (deathsper 1000 persons) during the period 1998–1999 with Grenada, Saint Vincent andthe Grenadines, Dominica and Saint Lucia recording crude death rates of 7.9,7.2, 8.0 and 6.4, respectively (PAHO, 2002). An examination of the overallmortality figures reveals that diseases of the circulatory system accounted forthe largest proportion of deaths in most eastern Caribbean countries during1999. Diseases of the circulatory system were the leading cause of death inDominica, Saint Lucia and Saint Vincent and the Grenadines, accounting for54.7 percent, 38.0 percent and 42.0 percent of total deaths, respectively (PAHO,2002). Cerebrovascular diseases, ischemic heart disease and hypertensioncomprised 23 percent of all deaths as reported in Grenada during 2000.

Nutritional status of children under 5Both under-nutrition and obesity constitute problems in children under 5 years ofage in Caribbean countries. While comprehensive data are not available for allcountries, PAHO’s (2002) publication Health in the Americas provides data forsome countries. PAHO reported a 6 percent prevalence of under-nutrition amongchildren aged 1–4 years in Saint Vincent and the Grenadines in 1999. However, theNutrition Unit Surveillance System of the Ministry of Health reported that in 2001

3. Rationale for FBDGs in the Caribbean



under-nutrition among young children was a low 0.23 percent while obesityamong this age-group stood at 11 percent.

In the Commonwealth of Dominica, the Health Information System of theMinistry of Health reported under-nutrition among children under 5 as 0.7percent while obesity in this age-group was 9.4 percent. In Guyana under-nutrition ranged from 12 percent in the 0–11-month age-group to 15 percent inthe 12–23-month age-group.

The Young Child Surveillance System of the Grenada Food and NutritionCouncil reported that in 2001 under-nutrition among young children was 4.0percent while 4.5 percent of this population was overweight.

The birth weight of infants continues to be monitored and used as an indicatorof nutritional status. During 1998–99 low birth weight (<2,500 grams) wasrecorded among 8 percent of total births in Grenada; 4.1 percent in Saint Vincentand the Grenadines and 14 percent in Guyana (PAHO, 2002).

Changing morbidity patterns As a result of the improvement in childhood mortality, there has been a generalincrease in average life expectancy throughout the English-speaking Caribbean.In 2000, this was estimated at 71.3 years, ranging from 64.5 to 78.9 years(Henry, 2001). In the same year, the gap between male and female lifeexpectancy was 4.9 years. The average proportion of the population aged 60years and older in these countries is 9 percent. This means there is an ageingpopulation, with women in particular living longer and being more at risk ofnon-communicable diseases (NCDs). The most prevalent NCDs in the regioninclude cardiovascular disease, hypertension, diabetes and cancer. All are linkedby common risk factors related to lifestyle – such as obesity, physical inactivity,poor nutrition and tobacco use.

Diet-Related Non-Communicable Diseases (NCDs)

HypertensionThe Ministry of Health in Saint Vincent and the Grenadines reported that in2000 the prevalence of hypertension was 5.8 percent in the 15–34 years age-group and 14.3 percent in the 35 and over age-group. In Dominica, a studyconducted by using an upper limit of 140/90, recorded a 20-percent prevalenceof hypertension in the 18–60 year age-group. Grenada’s ministry reported that8.8 percent of clinic attendees in 2003 were affected by hypertension.


3 Rationale for FBDGs in the Caribbean 7

Hypertension prevalence among males aged 25–74 years in Saint Lucia is 19–25percent and among females is approximately 28 percent (Riopel et al., 1986). Atthe threshold of 160/95 mm Hg, just 74 percent of individuals in Saint Luciawere aware of their condition; 59 percent were treated pharmacologically; andonly 35 percent were controlled. Men, particularly those under 55 years, wereless likely than women to have their blood pressure treated and controlled(Friesinger and Ryan, 1999).

DiabetesAlthough diabetes is under-reported on death certificates in the Caribbean(Reddy, 1998), it was estimated to be the fourth leading cause of death in 1995.Diabetes accounted for one in ten deaths that year out of a total of approximately4,000 deaths. Of note is the rapid increase in proportional mortality for diabetes,up from seventh place (4 percent) in 1980.

Prevalence data for diabetes are not available for most eastern Caribbeancountries. However, clinic and hospital admission data do provide usefulinformation. Using clinic data, the Ministry of Health in Grenada reported that,in 2003, 12 percent of clinic attendees were diabetic, while in Saint Vincent andthe Grenadines, the Ministry of Health reported that diabetes was found in 2.7percent of the 15–34 age-group and 6.6 percent of the 35 and over age-group. InDominica, 25 percent of admissions to the medical ward in 2000 were related todiabetes.

ObesityThe increasing trend in obesity is considered a major contributory factor inchronic disease prevalence in the Caribbean. Rising obesity levels –particularly among women – may be attributable to changes in traditional dietsand the adoption of relatively more sedentary lifestyles. In some countriesmore than half of adult women and more than a quarter of males are reportedto be obese.

Empiric data on obesity are not available for all countries; however, availabledata do indicate that since the 1970s obesity among adults has risen to epidemicproportions in the English-speaking Caribbean. This is illustrated in Figure 1(Henry, 2004). The most striking features of Figure 1 are: (a) the highprevalence of overweight, as indicated by Body Mass Index (BMI>25) andobesity (BMI>30); and (b) the consistent gender difference, showing that about25 percent of adult Caribbean women are seriously overweight, i.e. obese,which is almost twice as many as their male counterparts.



In 1996, results of the Dominica Food and Nutrition Council (DFNC) nationalFood Consumption Pattern and Lifestyle survey revealed that 47.9 percent of theadult population were obese (BMI >30.0).

When the data for obesity in young children and adolescents in the Caribbean arereviewed, the obesity epidemic in the region becomes even more worrying (seeFigure 2). Although the global prevalence of overweight amongst preschoolchildren is estimated at 3.3 percent, data collected from the Caribbean region showhigher rates, such as 9.0 percent for Dominica and 7.0 percent for Saint Vincent andthe Grenadines (CFNI, 2001).

Iron deficiency anaemiaDespite supplementation, fortification and dietary diversification programmesbeing implemented in the English-speaking Caribbean countries, iron deficiencyanaemia persists as a public health problem in all countries. The populationsubgroups most adversely affected by this condition are young children (1–4years); school-age children (5–16 years) and prenatal women.

A review of the data available on the prevalence of iron deficiency anaemia in theCaribbean indicates varying trends over the years, although the analysis of studyresults is compounded by the varying definitions of anaemia used. Based on the

Figure 1: Trends in adult overweight/obesity in the Caribbean

Source: Henry, 2004.

60

50

40

30

20

10

01970s 1980s 1990s

YEARS

Male

FemalePrev

alen

ce (

%)



WHO standards for anaemia, in 2003, the Grenada Ministry of Health (MoH)reported anaemia among infants (12 months) to be 65.2 percent; 14 percent amongantenatal women and 3 percent among postnatal women.

Dominica and Saint Vincent and the Grenadines were included in a three-countrystudy conducted by the CFNI in 1996 aimed at determining micronutrient statusamong the population (CFNI, 1997). The study results showed that for Dominica34.4 percent of young children (1–4 years) were anaemic based on the WHOstandard, as were 30.7 percent of school-age children (5–16 years) and 35.6 percentof prenatal women. For Saint Vincent and the Grenadines, the study was able toreport only on serum ferritin levels as haemoglobin levels were not measured. Basedon serum ferritin levels, 18.9 percent of young children were anaemic as were 42.2percent of school-age children and 41.8 percent of prenatal women (CFNI, 1997).

Food Consumption

Empirical food-consumption data over extended periods are not available forCaribbean countries, but crude estimates of energy intake can be gleaned fromecological analysis of FAO food-disappearance data. Since the 1970s there hasbeen evidence of an increasing availability of kilocalories (kcals) per person in theCaribbean, representing an abundance of energy to meet nutritional needs. Since

Figure 2: Trends in young child (0-5 yrs) obesity in the Caribbean

Source: Unpublished data CFNI, 2001.

12

10

8

6

4

2

0Antigua Dominica St. Kitts/Nevis St. Vincent

Country

1990

1999

Prev

alen

ce (

%)



the 1990s, there has also been a proliferation of food outlets where the majorofferings are fatty foods and refined carbohydrates. Added to this, a largerproportion of the population eat away from home on a daily basis.

Using a per capita recommended daily allowance of 2 250 kcals in 12 countries,food-disappearance data indicate that during the 1960s there was an overallinsufficiency of kilocalories: approximately 1900 kcal/daily/per person. Thisinsufficiency was reflected in the high rates of under-nutrition at that time. Fromthe 1970s onwards, the average daily availability of kilocalories per personincreased rapidly and currently stands at approximately 2 750.

FAO food-balance sheets for Dominica, for example, show an increasing trend in percaput supply per day energy requirement. For example, availability of the per capitakilocalories food supplies increased from 2 254 kcal in 1980 to 2 866 kcal in 1993,indicating increased supplies relative to standard requirements. For 2002, the trendsin food supply were not significantly different, with per caput supplies per day forenergy, protein and fat being 2 763 kcal, 82.4 g and 77.4 g, respectively. The 1996food-consumption survey identified high intakes of meats (pork and chicken) andfish, and inadequate consumption of fruits and vegetables among the populationsurveyed.

Changing infostyles include moremeals outside the home



Qualitative food-consumption data from the Caribbean indicate that theconsumption of food from animals and intake of sugar and salt have beenincreasing steadily since the 1980s. In contrast, consumption of fruits, vegetables,roots, tubers and legumes (ground provision) has been low or declining. Duringthis period, the dependence on imported foodstuffs has also increasedprogressively, while consumption of local agricultural production has declined. Anincrease in the intake of high-calorie foods and the decline in the consumption ofcereals, fruit, vegetables, legumes and ground provision, accompanied by asedentary lifestyle and changing patterns of physical activity, contribute to thegrowing problem of obesity.

Physical Activity

The protective effects of physical activity against obesity are substantial and wellknown (Hill, et. al. 2000). As with food consumption patterns there are no trendanalyses of physical-activity patterns in the Caribbean. There is, however,documentation of increased mechanization and decreased manual labour,improvement in transportation and low levels of physical exercise (Sinha, 1995;Henry et al, 2001). Results from a small study conducted by CFNI in three membercountries show that, on average, 45 percent of adults were sedentary (spent moretime in sleep and light activity than other activities).


Part two: Processof Developing FBDGs


15

This chapter describes the process of developing FBDGs. Figure 3 shows the stepsfor preparing dietary guidelines that were used in Dominica, Saint Lucia, Grenadaand Saint Vincent and the Grenadines. Each step in the process is explained indetail below.

FBDGs development in the four eastern Caribbean countries followed the modelproposed by INCAP as published by Peña and Molina (1999) and depicted inFigure 3.1 this model was first published in Spanish by Molina.

Figure 3: Steps for preparing food based dietary guidelines

Source: Peña, M. & Molina, V. 1999.

PLANNING CHARACTERIZINGTARGET GROUP

SETTINGOBJECTIVES

PREPARING TECHNICALGUIDELINES

EVALUATION IMPLEMENTATIONCORRECTING

ANDADJUSTMENT

VALIDATION PREPARINGFBDGs

TESTING THEFEASIBILITY OF THE

RECOMMENDATIONS

Introduction



The purpose of this step is the formation of the multi-sectoral national committee.The ideas and perspectives of different public and private sector institutions and theusers should be considered from the beginning in preparing the nutritionalguidelines. This step comprises:

• Identification of the project coordinator. • Training of project coordinators and resource personnel. • Mobilizing political support and sensitization of key stakeholders.• Convening a multi-sectorial national committee.• Formation of a task force.

Identification of project coordinators

Before the process of developing FBDGs can begin, a coordinator should bedesignated to lead the process. This coordinator should be able to dedicate asubstantial amount of time to working on the FBDGs. Training is required so thatthe coordinator has a clear understanding of the rationale for national FBDGs andthe steps for developing FBDGs.

In this project, project coordinators were appointed by their respectivegovernments and mandated with the task of leading the development process at thecountry level. In all four countries, the coordinators, appointed by their permanentsecretaries, were drawn from the ministries of health and agriculture and were allnutritionists by profession. Other resource personnel who were trained includedagriculturalists and communications specialists. Training was deemed necessarysince coordinators and other resource staff lacked all of the skills needed forcarrying out the task of developing FBDGs in their respective countries

Training of project coordinators and resource persons

Training allowed participants and facilitators to discuss issues such as strategies formobilizing political support; establishing multi-sectoral national committees andthe formation of national task forces. Political support from the highest level ofgovernment was deemed critical if the FBDGs were to form part of the NationalPlan Action for Nutrition (NPANs) and be used as tools for public education.

1STEP 1: Planning and organizing the work


Step 1 17

Mobilizing political support and sensitization of key stakeholders

To be effective, the development and dissemination of FBDGs require theparticipation of various sectors of society. The mobilization of political supportfrom the highest level of government is important and it is also vital that keypersonnel in the various sectors be sensitized at the outset regarding the process tobe used as well as their expected level of involvement. The following activitieswere conducted in order to seek political support:

• Project coordinator informed the permanent secretaries and key personnel in theministries of agriculture, health, education and social development of this project.

• FAO wrote to relevant ministries requesting their cooperation with the project.• A sensitization workshop was held (see below). Its aim was to sensitize key

stakeholders on the objectives and proposed activities of the project and helpthe project coordinators of the participating countries to obtain politicalsupport.

Sensitization in the Caribbean was facilitated through the hosting of a “virtualworkshop” (teleconference) using the facilities of the University of the West IndiesDistance Education Centre (UWIDEC). The UWIDEC site in each country servedas the meeting place for participants while the meeting was “chaired” from the siteat the Mona campus in Jamaica and lasted for approximately three hours. Thisobviated the need for a face-to-face meeting of participants from all four countries,thereby minimizing cost.

The teleconference was facilitated by CFNI and FAO, Rome. The 56 participantswere drawn from a number of agencies and organizations involved in food andnutrition-related programmes and services including the ministries of health,agriculture, education, social services and youth and culture. There were alsorepresentatives from the trade and commerce sector, academia, bureaux ofstandards and the media. The main issues discussed were:

• an overview of the TCP project under which the FBDGs would be developed; • the process to be used in developing the guidelines; • the benefits to individual countries in having culturally appropriate dietary

guidelines; • the role of various sectors in both development and dissemination of FBDGs

information;• the technical support which would be available to the countries; and• a review of individual country’s plans of action.

The virtual meeting ended with countries agreeing to continue discussing country-

1



specific strategies, preparing budgets based on local costs and finalizing workplans for developing the FBDGs.

Convening multi-sectoral national committees

An important part of the process is the formation of a multi-sectoral nationalcommittee on FBDGs. The main task of the multi-sectoral committee is to “takeownership” of the national FBDGs and to appoint a task force. It is recommendedthat the national committee is composed of representatives from the public sector(health, education, agriculture, economy, etc.), academia and the private sector(universities, professional associations, research institutes, consumer groups,chambers of commerce and industry, non-governmental organizations, etc.) andinternational and bilateral agencies. The participation of the various sectors allowsfor the multidisciplinary approach required for preparing the guidelines andfacilitates their implementation in the different entities.

Each of the four countries had a multi-sectoral national committee comprised ofover 30 personnel representing a wide range of government and non-governmentorganizations (NGOs) and agencies.

Formation of a task forceRealistically, most of the members of the multi-sectoral committee cannot beexpected to participate in development of the FBDGs on a frequent basis.Following the multi-sectoral committee meetings in the four countries, nationalFBDGs task forces were formed, comprising approximately 10 members chosenfrom the multi-sectoral committee. This task force guided the process ofdeveloping the national FBDGs, and task force members dedicated time for workon the development process.

The national committee appointed the task force (which was answerable to thenational committee). Task force members need to be appointed officially and givenenough time to work on the project. Box 2 gives examples of task force membersin Grenada. (The task force is an interdisciplinary group as Box 2shows.)

1


Step 1 19

1

The task forces used the first meeting to introduce the project, outline steps fordeveloping guidelines, identify data sources, and discuss the scope of work. Thetask force prepared a work plan document.

It is important that minutes of each meeting are kept so that good records ofdecisions exist – the process is a long one and there needs to be a consistent focus.Moreover, all commitment and consensus decisions should be recorded for eachmeeting in order to ensure the group keeps track of its objectives throughout theproject and does not become sidetracked.

Ministry of Health.

Ministry of Agriculture.

Ministry of Education.

Ministry Social Development.

Grenada Food & Nutrition Council.

St George University.

Grenada Chamber Industry and Commerce.

Conference of Churches of Grenada.

Grenada Media Workers' Association.

Marketing and National Importing Board.

Grenada Bureau of Standards.

Department of Youth.

Box 2: Membership of the Grenada National FBDGs Task Force



The purpose of this phase is to identify the target group, in order to diagnose thehealth and nutritional status of the target group to whom the dietary guidelines aredirected. The end product of this phase is a descriptive document that includes therisk factors and problems associated with the diet of the target group.

The diagnosis is based on a review of existing surveys, reports, and publications.The report should include information on the risk factors and problems associatedwith diet; epidemiological profiles; changes in morbidity mortality rates;nutritional status; education of the population; food availability, accessibility,consumption patterns, food composition and eating habits, distribution,classification and acquisition. The dietary patterns are analysed and the risk factorsand problems associated with diets determined. This phase comprises:

• Identification of the target group/ population.• Situation analysis on nutrition, health and risk factor.• Prioritization of health problems associated with diet and risk factor.

Identification of the target group/ population

There was consensus among the four countries that guidelines should be developedfor healthy families, using population over two years from urban and rural areas.

Situational analysis on nutrition, health and risk factors

The product of this activity is a descriptive document highlighting the risk factorsand problems associated with the population’s diet. This stage included collectionand analyses of information on nutrition, health and risk factors and preparation ofthe report on the nutrition situation in the country. Box 3 suggests the type ofinformation that needs to be collected and included in the situation analysis.

Information for compiling the situational analysis was obtained from the variousagencies within each country. Sources used included annual reports from theministries of health, agriculture and education in addition to reports from thevarious national statistical institutes/units. Data from published and unpublishednational and community-based surveys and studies were also used.

2

STEP 2: Characterizing the target group


Step 2 21

Information on the eating habits of population groups was available for theCommonwealth of Dominica and Grenada. Data for Dominica were obtained froma national food consumption survey undertaken in 1996. For Grenada, informationwas available from a qualitative food consumption study undertaken on arepresentative sample of the population in 2003. Dietary pattern data were notavailable for Saint Lucia and Saint Vincent and the Grenadines and consequentlyhad to be obtained from the population groups quickly.

At times, the cost of conducting quantitative food consumption studies and also thetime needed to carry them out is prohibitive. In the case of two countries in theproject, the countries conducted qualitative studies using the focus-groupmethodology to obtain information on the dietary habits of their population. Trainingin the methodology was facilitated in-country and involved eight participants fromSaint Vincent and the Grenadines and six from Saint Lucia. Those trained weremainly nutrition personnel drawn from the ministries of health and agriculture.Additional personnel trained were from the Bureau of Statistics (Saint Vincent andthe Grenadines) and the Ministry of Social Transformation (Saint Lucia).

The training involved both theory and practice, and enabled participants to designand conduct focus group discussions on information collected. The core of trained

2

ak

A. INTRODUCTION

B. RISK FACTORS AND PROBLEMS ASSOCIATED WITH DIET

1. Epidemiological Profile

1.1 Changes in morbidity

1.2 Nutritional Status

2. Education of the population

3. Foods

3.1 Availability

3.2 Accessibility

3.3 Consumption

3.4 Composition

4. Eating Habits - family

4.1 Distribution - intra familial

4.2 Classification - fads and fallacies

4.3 Acquisition - food purchase, food storage

C. CONCLUSIONS

Box 3: Contents for the situational analysis document



persons in each country was then able to carry out studies on the dietary patternsof their respective populations using the focus group methodology. This allowedfor the provision of information on dietary habits for the situational analysis whichwould form the basis of characterizing the target group to whom the dietaryguidelines would be directed.

Prioritization of health problems associated with diet and risk factors

A two-day meeting with the multi-sectoral committee in each country wasconducted with the following objectives:

• Present the health and nutrition situation of the country.

• Discuss implications of the health and nutrition situation and determine strategiesfor alleviating them.

• Determine priority problems and set national objectives to be addressed throughfood-based dietary guidelines.

Table 1 presents the problems identified by the multi-sectoral group. The problemsare prioritized in terms of their scope, the feasibility of solving them,recommendations and priorities selected.

Based on the health and nutrition situation presented at the multi-sectoralcommittee meeting, the task force participants were asked to prioritize theproblems in order to arrive at a list of key issues that could be addressed throughFBDGs.

2

Meetings are held to discuss nutrition priorities.


Step 2 23

To assist in this process, each member of the committee is provided with a“Decision Matrix” (Molina et al., 2001). The matrix ranks problems in terms ofmagnitude, viability and impact on a scale of zero to ten. Once the points areassigned to each problem, scores are added and the problems with the highestscores are selected. Table 2 shows the decision matrix prioritization of food andnutrition problems for Saint Lucia and Saint Vincent and the Grenadines.

2

Table 1: Problems identified by the multi-sectoral groups

Saint Lucia Grenada Saint Vincent Dominicathe Grenadines

1 Obesity

2 Physical inactivity

3 Food consumption

Quality

Quantity

Choice

4 Food handling

5 Teen pregnancy

6 Food accessibility

and availability

7 Ageing population

8 Protein, Energy

Malnutrition (PEM)

9 Poverty

10 Low birth weight

11 Alcoholism

1 Chronic diseases

2 Physical

Inactivity

3 Food

consumption

4 Nutrition intake

of fat, sugar and

salt

5 Food

preparation use

of barbeque

6 Iron deficiency

7 Low birth

weight

8 Accessibility and

availability

1 Obesity

2 Chronic disease

3 Physical

inactivity

4 Unhealthy

lifestyles

5 Inadequate

consumption of

fruit and

vegetables

6 Anaemia (iron

deficiency)

7 Food

preparation and

preservation

8 High

consumption of

fats, salt, sugar

9 Inadequate

consumption of

fat and

processed food

10 Low availability

of food (fruit

and vegetables)

1 Chronic non-

communicable

disease/obesity

2 Physical inactivity

3 Food preparation

4 Inequitable distribution

5 Iron deficiency

6 Knowledge and

education

7 Unemployment/poverty

8 Food security/policy

9 Female head of

household

10 Culture



The problems were qualified on a scale of zero to ten, using the three criteria of (i)magnitude, (ii) viability and (iii) impact. The problems with high scores wereselected, and grouped into categories. The nine priority problems in the four projectcountries were listed and rankedo.

2

Table 2: Decision matrix prioritization of food and nutritionproblems, Saint Lucia and Saint Vincent and the Grenadines

Saint Lucia M V I S Saint Vincent + M V I S

1 Obesity 9 10 10 29 1 High consumption 10 10 10 30

fats, salt, sugar

2 Physical inactivity 9 8 9 26 2 Physical inactivity 9 9 9 27

3 Food consumption

quality, quantity choice 9 8 10 30 3 Unhealthy lifestyles 6 8 7 21

4 Food handling 9 8 8 25 4 Obesity 10 9 10 29

5 Teen pregnancy 5 4 8 17 5 Chronic disease 9 10 9 28

6 Food availability 5 4 8 17 6 Inadequate 8 9 9 26

consumption of fruit

and vegetables

7 Aging population - - - - 7 Inadequate 9 10 10 29

consumption of fast

and processed food

8 PEM 9 8 8 25 8 Low availability 6 7 8 21

of food (fruit and

vegetables)

9 Poverty - - - - 9 Anaemia 9 9 9 27

(iron deficiency)

10 LBW - low 10 Food preparation

birth weight and preservation

11 Alcoholism 9 8 9 26

Note: Qualify the problems on scale where 0 = less to 10 = more. M: Expresses Magnitude and refersto the magnitude of the problem. V: Represents Viability or feasibility to solve the problem throughthe proposed educational intervention. I: Represents the impact on health if the problem is solved.S: Is the sum of the results of the three considered factors.

the Grenadines


Step 2 25

These problems were then put into three categories: diet related; related to nutritionstatus and related to beliefs and practices (see Box 4).

2

Diet-related

1. High consumption of fat, sugar, salt.

Related to nutrition status

2. Obesity.

3. Iron deficiency anaemia.

4. Chronic diseases.

5. Physical inactivity.

6. Protein energy malnutrition (PEM)

Related to beliefs and practices

7. Inappropriate food preparation food handling.

8. Low consumption of fruit and vegetables.

9. Alcoholism.

Box 4: Categorization of major problems



The purpose of this step is the definition of the FBDGs objectives, which should beaimed at preventing and reducing the priority risks and problems detected in theprevious step, as well as promoting healthy diets and lifestyles. Based on thepriority areas agreed at the multi-sectoral committee, nutrition personnel setgeneral objectives for the FBDGs. Table 3 outlines the objectives for each problem.

3

STEP 3: Setting the objectives for the FBDGs

Multisectoral committees ensure that FBDGs are suited to the food situation in thecountry.


Step 3 27

3

Table 3: Prioritized problems and objectives of nutrition guidelines

Problem Objective of nutrition guidelines

Obesity

Chronic diseases

High consumption of fat,

sugar, salt

Physical inactivity

High alcohol

consumption

Low consumption of

fruits and vegetables

Inappropriate food

preparation food-

handling practices

Protein energy

malnutrition (PEM)

Iron deficiency anaemia

Dominica only

Inequitable distribution

Food security

Knowledge and

education

For Saint Lucia, Grenada and Saint Vincent the Grenadines

Reduce prevalence of obesity and nutrition related chronic

diseases.

For Dominica

To decrease the prevalence of chronic diseases and obesity in the

population


Promote healthy lifestyle behaviours with special focus on

increased physical activity and decreased alcohol consumption

For Dominica

To promote the importance of healthy lifestyle with special focus

on physical activity


Promote healthy food choices with respect to variety, quality,

quantity.

For Dominica

To encourage the use of proper food preparation and practices

in order to improve the quality of food consumed.

Reduce the incidence of PEM and iron deficiency anaemia.

To decrease the incidence of anemia in the population.

To ensure adequate quantities and quality of food for each

member of the household.

To provide relevant nutrition information using appropriate

methodology to promote healthy food choices with respect to

variety, quality and quantity.



Once objectives are established, the next step is to define the technicalrecommendations. This step must be carried out by nutrition experts and it iscomprised of the following:

• Definition of the nutrition goals and nutrient recommendations (calories,macro- and micro-nutrients).

• Definition of the food groups, the profile of nutrients for each group, thesize and number of portions that ensure appropriate food intake in termsof quantity and variety.

• Definition of technical recommendations.

The end product of this step is a technical document that summarizes the nutritionalgoals, nutrient recommendations, and additional suggestions for preventing theproblems detected and promoting a healthy diet and lifestyle.

This technical document contains the scientific foundations that support thenutritional guidelines and is aimed at health and nutrition professionals and not thegeneral public.

Definition of nutrient goals and nutrient recommendations (calories,macro- and micro-nutrients)

In the project, risk factors for the target group and the daily Caribbeanrecommendations from CFNI were used to define the nutrient goals for theCaribbean population. A reference framework which covers the energyrequirements of the majority of the population was established. For each country’spopulation, the framework or categories of reference established was: 2 800, 2200 and 1 600 kcals, to ensure that energy intake needs from different age- andgender-groups are covered (see Table 4).

Once groups were defined, nutrient goals for each group were calculated (theseincluded kilocalories, macro- and micronutrients). Results of the Nutrient goals arepresented in Table 5.

4

STEP 4: Preparing the technical guidelines


Step 4 29

4

Table 4: Population groups covered by three energy requirementlevels

1 600 kcals 2 200 kcals 2 800 kcals

• Preschool

children (both

sexes).

• Schoolchildren (both

sexes).

• Male adults (low

activity).

• Elderly people

• Adolescents/adult

women.

• Pregnant women (low

activity).

• Male adolescents (moderate to

intense activity).

• Male adults (moderate to intense

activity).

• Adult women (moderate to intense

activity).

• Pregnant women (moderate to

intense activity).

• Breastfeeding women.

Table 5: Population framework nutrient goals

Nutrient distribution

Nutrients (%) Kcal Grams

2 800 Kcal

Carbohydrate 60 1 680 420

Protein 15 420 105

Fat 25 700 78

Total 100 2 700 -

2 200 Kcal

Carbohydrate 60 1 320 330

Protein 15 330 83

Fat 25 549 61

Total 100 2 199 -

1 600 Kcal

Nutrients (%) Kcal Grams

Carbohydrate 60 960 240

Protein 15 240 60

Fat 25 400 44

Total 100 1 600



Definition of food groups and calculation of the recommended diet

Food groups also need to be defined. The food groups from the Food ExchangeLists and CFNI food composition tables for use in the English-speaking Caribbeanwere used as the basis for the steps (see Box 5).

Calculation of the recommended diet

Using the defined food groups, the profile of nutrients of each group, the size andnumber of portions that ensure appropriate food intake in terms on quantity andvariety were determined. Table 6 outlines a summary of recommended diets.

4

1. Staple food which includes bread, rice and cereal.

2. Legumes and nuts.

3. Dark green leafy, yellow and other starchy vegetables.

4. Citrus fruit and juice.

5. Food from animals.

6. Fat and substitutes.

7. Sugars.

Box 5: Food groups that should be used in the FBDGs

Table 6: Summary of portions from different food groups needed forthe three energy requirement levels established*

Food group No. of portions per diet

1 600 kcal 2 200 kcal 2 800 kcal

Staples 7 11 12

Legumes/nuts 1 2 8

Vegetable 2 5 5

Fruits 5 8 11

Food From Animals 4 3 7

Fats 3 7 6

Sugar 5 6 8

* For reference, see Table 4 above.


Step 4 31

Definition of technical recommendations

The technical recommendations from the guidelines are selected on the basis oftwo criteria: the objectives of the guidelines and their potential for implementationby the target group. The potential for implementation is assessed throughbehavioural tests, which are discussed below under Step 5. In order for thepopulation to remember them and to facilitate their dissemination through themedia, the ideal number of messages in the nutrition guidelines is between six andeight. It was recommended that the food guide should have three characteristics:promote variety, appropriate portion size and be culturally acceptable to thepopulation.

During this step the nutrition recommendations are written by technical experts inorder to solve the problems identified earlier. To facilitate the process the chart thatis presented as Table 7 was used. The chart will allow nutritionists to analyse eachproblem, and identify critical nutrients related to the problem, pinpoint criticalfoods and practices related to the problem and give specific recommendations tosolve the problem.

4



4

Tab

le 7

: Fo

rmu

lati

on

an

d A

nal

ysis

of

the

Tech

nic

al R

eco

mm

end

atio

n f

or

FBD

Gs*

Ref

ers

to t

he

pri

ori

tize

d

pro

ble

m e

stab

lish

ed in

Step

2 (

see

Tab

le 2

).

Pro

ble

m o

f h

ealt

h

and

nu

trit

ion

Cri

tica

l nu

trie

nt

Cri

tica

l fo

od

Prac

tice

s/h

abit

s/b

elie

fs

rela

ted

to

th

e p

rob

lem

Tech

nic

al

reco

mm

end

atio

n

to s

olv

e th

e p

rob

lem

Ref

ers

to n

utr

ien

ts

invo

lved

in t

he

pro

ble

m.

Ref

ers

to f

oo

ds

rela

ted

wit

h

nu

trie

nts

iden

tifi

ed.

Ref

ers

to b

ehav

iou

rs w

hic

h

affe

ct t

he

pro

ble

m.

Ref

ers

to t

he

tech

nic

al a

dvi

ce

that

exp

erts

giv

e to

so

lve

the

pro

ble

m.

Exam

ple

s

Ob

esit

yH

igh

fat

s, h

igh

Cab

oh

ydra

te

(esp

ecia

lly s

ug

ar)

and

alc

oh

ol i

nta

ke.

Low

fib

re in

take

.

Hig

h p

ork

, bee

f,

po

ult

ry, g

oat

an

d

mu

tto

n m

eat,

refi

ned

pro

du

cts,

wh

ite

flo

ur,

wh

ite

rice

, car

bo

nat

ed

and

sw

eete

ned

bev

erag

es, c

akes

,

pas

trie

s an

d p

ies.

Low

inta

ke o

f

veg

etab

les,

cer

eals

and

fru

its.

Bel

ief

of

wea

lth

an

d

pro

sper

ity.

Cu

ltu

ral p

erce

pti

on

th

at m

en

are

mo

re a

ttra

cted

to

hea

vier

wo

men

.

Ad

dit

ion

of

fats

wh

en

coo

kin

g.

Easy

acc

ess/

con

ven

ien

ce.

Larg

e p

ort

ion

siz

es.

Sed

enta

ry li

fest

yles

.

Incr

ease

ph

ysic

al a

ctiv

ity.

Dec

reas

e co

nsu

mp

tio

n o

f

pro

du

cts

wit

h a

dd

ed s

ug

ar.

Incr

ease

co

nsu

mp

tio

n o

f

wat

er.

Incr

ease

co

nsu

mp

tio

n o

f h

igh

-

fib

re f

oo

ds,

veg

etab

les,

fru

its.

Dec

reas

e in

take

of

stew

ed a

nd

frie

d f

oo

ds.

Trim

fat

s o

ff m

eats

bef

ore

coo

kin

g.

Red

uce

po

rtio

ns

of

hig

h-

ener

gy

foo

ds


Step 4 33

4

Tab

le 7

(co

nti

nu

ed):

Fo

rmu

lati

on

an

d A

nal

ysis

of

the

Tech

nic

al R

eco

mm

end

atio

n f

or

FBD

Gs*

Hig

h c

on

sum

pti

on

of

fats

,

sug

ar a

nd

sal

t

Pro

ble

m o

f h

ealt

h

and

nu

trit

ion

Cri

tica

l nu

trie

nt

Cri

tica

l fo

od

Prac

tice

s/h

abit

s/b

elie

fs

rela

ted

to

th

e p

rob

lem

Tech

nic

al r

eco

mm

end

atio

n

to s

olv

e th

e p

rob

lem

Hig

h c

on

sum

pti

on

of

tota

l an

d

satu

rate

d f

ats.

Hig

h c

on

sum

pti

on

of

refi

ned

carb

oh

ydra

te.

Hig

h c

on

sum

pti

on

of

sod

ium

.

Hig

h co

nsum

ptio

n of

mea

ts a

nd f

ried

food

s/ba

kes/

fish

/

vege

tabl

e ca

kes

(spi

nach

and

calla

loo)

, veg

etab

le

patt

ies

and

past

ries

.

Hig

h co

nsum

ptio

n of

swee

tene

d, d

rink

s,

cand

ies,

cho

cola

tes,

swee

t bi

scui

ts.

Hig

h co

nsum

ptio

n of

salt

ed m

eats

(pig

tail,

codf

ish)

, can

ned

mea

ts a

nd

vege

tabl

es a

nd

seas

onin

gs, s

alty

snac

ks s

uch

as c

hips

and

chee

se c

urls

.

Easy

acc

ess/

con

ven

ien

ce.

Pref

eren

ce f

or

the

tast

e o

f

frie

d f

oo

ds.

Freq

uen

t u

se o

f fa

st f

oo

ds.

Trad

itio

nal

ho

liday

mea

ls

(ham

, cak

es, s

oft

dri

nks

).

Ad

dit

ion

of

salt

to

fo

od

.

Use

low

fat

met

ho

d in

co

oki

ng

and

fo

od

pre

par

atio

n.

Red

uce

th

e u

se o

f p

roce

ssed

,

pac

kag

ed a

nd

can

ned

fo

od

.

Red

uce

inta

ke o

f sa

lt a

nd

sod

ium

.

Red

uce

th

e u

se o

f fa

st f

oo

ds.

Red

uce

fat

inta

ke.

Red

uce

inta

ke o

f su

gar

an

d

swee

t p

rod

uct

s.



4

Tab

le 7

( c

on

tin

ued

): F

orm

ula

tio

n a

nd

An

alys

is o

f th

e Te

chn

ical

Rec

om

men

dat

ion

fo

r FB

DG

s*

Phys

ical

Inac

tivi

ty

Pro

ble

m o

f h

ealt

h

and

nu

trit

ion

Cri

tica

l nu

trie

nt

Cri

tica

l fo

od

Prac

tice

s/h

abit

s/b

elie

fs

rela

ted

to

th

e p

rob

lem

Tech

nic

al

reco

mm

end

atio

n

to s

olv

e th

e p

rob

lem

Car

bo

hyd

rate

.Co

mpl

ex

carb

ohyd

rate

foo

d.

Wat

er.

Incr

ease

d u

se o

f TV

/DV

D/c

able

.In

crea

se p

hys

ical

act

ivit

y.

Incr

ease

d

use

of

veh

icle

s fo

r

mo

bili

zati

on

.

Ch

oo

se a

var

iety

of

foo

ds.

Bel

ief

that

ph

ysic

al a

ctiv

ity

is

inap

pro

pri

ate

for

old

er

per

son

s.

Incr

ease

wat

er c

on

sum

pti

on

.

Low

leve

l of

sch

edu

led

ph

ysic

al e

du

cati

on

acti

vity

in s

cho

ols

.N

on

-su

pp

ort

ive

envi

ron

men

tto

ph

ysic

al e

du

cati

on

.

Bu

ild p

hys

ical

act

ivit

y in

to

dai

ly li

fe.

Inap

pro

pri

ate

foo

d

pre

par

atio

n a

nd

han

dlin

g

Incr

ease

d s

atu

rate

d

fats

.

Loss

of

crit

ical

wat

er s

olu

ble

vita

min

s (C

& B

).

Mea

ts -

beef

, por

k,

poul

try.

Veg

etab

les

and

frui

ts.

Co

nve

nie

nce

of

BB

Q a

nd

fri

ed

fast

fo

od

s

Ove

rco

oki

ng

/bo

ilin

g

veg

etab

les.

Un

safe

fo

od

pre

par

atio

n a

nd

han

dlin

g p

ract

ices

.

Peel

ing

an

d s

oak

ing

veg

etab

les

bef

ore

co

oki

ng

an

d u

se.

Use

co

oki

ng

met

ho

ds

that

con

serv

e n

utr

ien

ts.

Use

saf

e fo

od

han

dlin

g a

nd

san

itat

ion

pra

ctic

es.


Step 4 35

4

Tab

le 7

(c

on

tin

ued

): F

orm

ula

tio

n a

nd

An

alys

is o

f th

e Te

chn

ical

Rec

om

men

dat

ion

fo

r FB

DG

s*

Iro

n d

efic

ien

cy a

nae

mia

Pro

ble

m o

f h

ealt

h

and

nu

trit

ion

Cri

tica

l nu

trie

nt

Cri

tica

l fo

od

Prac

tice

s/h

abit

s/b

elie

fs

rela

ted

to

th

e p

rob

lem

Tech

nic

al

reco

mm

end

atio

n

to s

olv

e th

e p

rob

lem

Iro

n, V

itam

in C

, B6

pro

tein

.

Low

con

sum

ptio

n of

calla

loo,

spi

nach

,

drie

d pe

as a

nd

bean

s, r

ed m

eats

,

orga

n m

eats

(liv

er,

kidn

ey, h

eart

s), p

ak

choi

and

bee

ts.

Vit

amin

C r

ich

frui

ts

and

vege

tabl

es.

Gre

en b

anan

a is

bel

ieve

d t

o b

e

hig

h in

iro

n.

Org

an m

eats

are

avo

ided

bec

ause

of

hig

h c

ho

lest

ero

l

con

ten

t.

No

t ea

tin

g V

itam

in C

an

d ir

on

rich

fo

od

to

get

her

.

Incr

ease

co

nsu

mp

tio

n o

f g

reen

leaf

y ve

get

able

s.

Use

org

an a

nd

red

mea

ts

mo

der

atel

y.

Incl

ud

e le

gu

mes

pea

s an

d

bea

ns

in t

he

die

t.

Incl

ud

e fr

uit

or

fru

it ju

ices

wit

h ir

on

-ric

h m

eals

.

Incr

ease

co

nsu

mp

tio

n o

f

Vit

amin

C r

ich

fru

its

and

veg

etab

les.

Enco

ura

ge

pra

ctic

es w

hic

h

incr

ease

bio

avai

lab

ity

of

iro

n.

* Th

e ch

art

was

dev

elo

ped

by

INC

AP

and

th

e N

utr

itio

n In

stit

ute

an

d F

oo

d H

ygie

ne

fro

m C

ub

a



Table 8 gives a summary of the range of technical recommendation for the FBDGsand the frequency in which this recommendation was mentioned by committeemembers. Table 9 outlines the preliminary recommendations for the Caribbean.

4

Table 8: Summary of technical recommendation for FBDGs

Technical Recommendations Frequency

Reduce fat intake.

• Saturated fats and cholesterol.

• Trim fat off meats before cooking. 4

Reduce portion size.

• Reduce portions of high-energy foods. 2

Reduce sugar intake.

• Refined carbohydrates.

• Sweet products. 4

Reduce alcohol intake.

• Use alcohol sparingly.

• Less alcohol in food preparation. 3

Less frequency in snacks and fast foods.

• Salty snacks.

• Use dense, more nutritious snacks. 3

Select foods low in energy. 1

Reduce intake of salt and sodium. 2

Increase physical activity.

• Build physical activity into daily life. 4

Increase water consumption. 3

Increase fibre intake of food. 2

Increase vegetable and fruits.

• Increase frequency and quantity.

• Increase portion size.

• Timely introduction in the diet of young children. 8

Reduce processed, canned and packaged foods. 1

Appropriate preparation methods.

• Nutrient saving methods.

• Low fat cooking methods. 4

Safe food handling and sanitation practices. 2

Reduce smoked, salted and cured food. 1

Moderate red meat intake. 1

Increase legumes intake. 1

Appropriate food combination.

• Increase bioavailabilty of iron. 3

Variety of food. 4

Increase calcium-rich food. 1

Increase fish, seeds, nuts. 1


Step 4 37

4

Table 9: Preliminary Technical Recommendations

Technical Recommendations for the Caribbean

• Eat a variety of foods every day.

• Eat larger portions of vegetables and fruits daily.

• Reduce fat intake using less fat in cooking.

• Trim fat off meat before cooking.

• Reduce sugar and sweet products intake.

• Avoid high fat/salty snacks and fast foods.

• Increase physical activity, build physical activity into daily life.

• Consume at least 8 glasses of water a day.

• Use alcohol sparingly also in food preparation.

• Appropriate food combination.

• Increase bioavailabilty of iron.

• Use appropriate preparation methods:

• nutrient saving methods

• low fat cooking methods

• salt consumption.



Table 10 shows a comparison of the problems, objectives and technicalrecommendations. These recommendations need to be tested on the population.

4

Table 10: Comparison of problems, objectives and technicalrecommendations

Problem Objective Technical Recommendation

Obesity

Chronic diseases

High consumption of fat,

sugar and salt

Physical inactivity

High alcohol

consumption

Low consumption of

fruits and vegetables

Inappropriate food

preparation and food-

handling practices

Protein Protein Energy

Malnutrition (PEM)

Iron deficiency anaemia

Reduce incidence of

obesity and nutrition

related chronic diseases,

Promote healthy lifestyle

behaviours with special

focus increase physical

activity and decrease

alcohol consumption.

Promote healthy food

choices with respect to

variety, quality, quantity,

Reduce the incidence of

PEM and iron deficiency

anaemia,

1. Reduce fat intake using less fat

in cooking and trimming fat off

meats before cooking

2. Reduce the amount of sugar

used. Choose to have less sweet

beverages and sweet products.

3. Use less salt when cooking and

when eating.

4. Build physical activity into your

daily life. Exercise at least one

hour every day.

5. Make water your drink of

choice several times every day.

(Drink at least 8 glasses of water a

day.)

6. If you use alcohol do so

sparingly both in drinking and in

food preparation.

7. Choose to eat a variety of foods

every day.

8. Eat larger amounts of

vegetables and fruits daily.

9. As frequently as possible, use

steaming, boiling and baking

instead of frying and barbequing.

10. Every day, add to your regular

meals foods such as citrus fruits,

guavas, garden cherries or fresh

tomatoes,


Step 5 39

The purpose of this step is to test the feasibility of the recommendations throughbehavioural trials and to develop a graphic that will be understood by thepopulation. This step comprises:

Testing the feasibility of the recommendation

This step included: design of field-testing methodology for behavioural trails;training in field methods for household trials; collection of the information analysisand interpretation (see Figure 3 below).

Behavioural trials: Behavioural trials must be conducted in order to ascertain whetherthe messages are understood and if there is willingness and capacities, motivations ofthe target population to follow the recommended FBDGs. Behavioural trials are asmall-scale field test with sample groups from the target population to see if the targetpopulation will be able to practise behaviours that will be promoted.

The trial investigates whether the target audience likes and can carry out therecommendations and its reactions to such recommendations. In addition, the trialhelps ascertain the appropriate language to be used in the messages about theguidelines and the motivation for implementing the recommendations. The resultof this step is a reconciliation between technical theory and what is feasible fromthe standpoint of the target population.

5

Behavioural trials can help in developing FBDGs in a number of ways, including:

• Identifying and analysing if behaviours or aspects of recommended behaviours for each

food group and portions per age were (or were not) adopted.

• Pinpointing the changes that could be made in the adoption of behaviours or aspects of

behaviours.

• Detecting the reasons (cognitive, resource oriented or skill oriented) that facilitated or

hindered the adoption of recommended behaviours.

• Ascertaining how to reinforce the teaching of recommended behaviours.

• Refining the teaching strategies and reinforcing the recommended behaviours.

STEP 5: Testing the feasibility of the recommendations anddeveloping the pictorial food graphic

Box 6: Reasons for behavioural trials



Design of the field-testing methodology

The design of the field testing includes:

• Developing and pre-testing the instrument.

5

Analysis and Interpretation of the Data

Refined Practical Behaviours

Methodology for

Behaviouraltrial

Planning

1

2 Characterizing Target Group

3 Setting Objectives

Preparing Technical Guidelines 4

5

Develop instruments Develop instruments graphic

recommendations

Pre-test FG the recommendations

Validate the outlines of the graphic

in st r u m e n ts

Adapt instruments to interviews for BT

Validate the two chosen graphic

Instrument A – Initial Interview

ONE WEEK Trial of the recommendation

Instrument B – Final interview

Duration

Testing the Feasibility of the Recommendations

Field work made by the teams

Figure 3: Testing the feasibility of the recommendations

Source: Christa de Valverde, INCAP

Recommendations in terms of food need to be:

• based on foods that are already available in houses or in communities;

• based on foods that are accessible with respect to cost;

• consistent with resources and local technology; and

• compatible with cultural beliefs related to the correct way of eating.


Step 5 41

5

• Sample selection.

• Training staff.

• Defining the timetable, data collection and tabulation

• Analysing data.

Developing and pre-testing the instrument

Specific forms were developed in order to compile and record the information,depending on the technique to be used and the information required:

Focus Group Form: Preliminary forms to carry out focus groups were developedfor each of the recommendations in order to validate them with the targetpopulation. The purpose of this activity was: (a) to adapt the technicalrecommendations to the local language; (b) to assess if respondents understoodthem; (c) determine if respondents agreed with the statement (or not) and why. Inaddition, the forms were developed to compile information regarding respondents’food practices and, by doing so, if they perceived benefits and barriers in additionto describing people’s perceptions regarding variety and food groups.

Initial Interview Form: For these instruments, the project staff, were asked toadapt the focus groups instruments into individual interviews, leaving enoughspace to take notes and write some observations (see Annex 1 and 2).

Recommended Practices/Reminder Card of the Recommendation: These cardsare used to give an explanation of the recommendation and motivate the head ofhousehold to follow it. For these instruments field workers were asked to:

• Develop an introduction.

• Make cards with reminders of each recommendation to be left in each household.

• Write the benefits that the population would experience if they practised therecommendation. These benefits should come from participants in the pre-testing,as to what they perceive as benefits .

Graphic/Diagram Validation Form: This form was developed to validate thedifferent graphics in order to identify which graphic the population thought bestrepresented their country (and why) and which graphic respondents would like tohave their FBDGs (see Annex 3).

Final Interview Form: This was the final form used to conduct individualinterviews in the behaviour trials. This form was used to ascertain if themother/father followed the recommendation, what happened when they did, if theywere prepared to follow the recommendation and why.



Sample selection

The sample selection for the behaviour trials was conducted by dividing the islandinto four sections, corresponding to the cardinal points. Variables used were age,education, and geographic location. In each of the sections or constituency the teamwas asked to test the nine recommended practices twice (urban and rural) (onerecommended practice for each household). The largest villages in the constituencywere selected. Box 7 describes the profile of participants.

Staff training

The team and the coordinator responsible for carrying out the behavioural trials hadprevious training in techniques such as focus groups. The team was trained in thefield-testing methodology and participated in all the steps mentioned above.

5

Profile of participants

Behavioural trials were conducted with 87 households in Saint Vincent and theGrenadines: 78 on the mainland and 9 in the Grenadines. The trials were conductedin order to test the efficacy of nine technical recommendations from the FBDGs.

Ten homes in each constituency of Saint Vincent and the Grenadines were surveyed,and the largest villages in the constituency selected. Variables were age andeducation (primary and secondary and tertiary) and geographic location.

The age range was from 18-79 years. More than two-thirds of respondents hadattained primary school education; less than one-third had attained secondary andtertiary education. Of those interviewed, the majority of respondents werefemales: less than 10 men were interviewed.

Interviews were carried out with heads of households. Respondents received twovisits: an initial visit to discuss the recommendation with the household head, anda final visit one week later to ascertain the respondent's reactions to therecommendation and if the recommendation was followed.

The ten houses in each constituency were tested on all nine recommendations.Respondents were given reminder card of the recommendations, which they cardsfried to follow for one week. One week later during the final interview they werereminded of the recommendation and questioned on their ability to follow it.

Box 7: Saint Vincent and the Grenadines behavioural trial


Step 5 43

Design the timetable, data collection and tabulation

Figure 4 gives an example of the timetable that was devised to allow teams to beginthe field work.

The duration of the behavioural trials depended specifically on the number offield workers each of the countries had. The basic process used 13 describedbelow:

The Home visit or a meeting with the selected household.

The Initial interview with the head of the household to discuss therecommendation with the household head, where an explanation of therecommendation was given and the woman or man was encouraged to follow therecommendation for a week (Annex 2). In some cases, a demonstration andsampling of recommended foods were offered. The card “RecommendedPractice” was given to the household.

The Final interview included a follow-up visit and final interview in order to find

5

Figure 4: Timetable in St. Vincent and the Grenadines

HOUSEHOLD TRIALS FOR FBDGs SAMPLE SELECTION

Form Dates Location No. of Interviewer’s Constituencieshouseholds name

Initial interview (A)

Week trial

Final interview (B)


Week trial

Final interview (B)


Week trial

Final interview (B)


Week trial

Final interview (B)

Southern

Grenadines

Northern

Grenadines

Rural North

Urban North



out if the women/men followed the recommendation, what happened whenthey did, if they were prepared to continue to follow the recommendation andwhy (see Annex 2).

Box 7 gives details of how a recommendation 1 was tested in Saint Vincent and theGrenadines:

Data analysis

After the team recorded the data in the specific forms developed for that purpose,the next step was to code, tabulate and organize the data for each of therecommendations tested.

In each country the first activity was to examine and tally both sets of interviewes(initial and final) for the recommendation to be used. The forms used in the

5

Recommendation 1: Use less fat in cooking and trim fat off meats before

cooking.

This recommendation was tested by 10 women, 7 from the rural area, 2 from the

urban area and 1 from the Grenadines. The respondents were aged between 21

and 79 years old, had primary- and secondary-level education, and there was an

average of 7 people in each of the respondent's homes.

• Eight persons or less added butter or margarine to bread, corn, rice.

• Seven or less used vegetable oil for frying (chicken, fish, chips, luncheon, salt fish,

vegetables),

• Ten added margarine or butter to already cooked foods.

• Less added fat (mayonnaise/salad cream) to different salad (potato, breadfruit,

coleslaw, vegetables).

• Nine out of ten trimmed fat off meat and chicken before cooking or when

cleaning the meat, while six reported trimming fat after cooking.

• Persons fried the fat from chicken and reused it as oil.

• When asked if they could prepare foods in other ways, all answered yes for

boiling (6), steaming (5), baking (3), roast, grill or BBQ (1).

• Four of them remembered the recommendation very well, 6 partially.

Most respondents stated that they were able to follow the recommendation,

mentioning that they were using less fat and oil and baking instead of frying. They said:

The other three were able to state they were able to follow it somewhat. One

person stated that it was difficult to cut down on fats because it made the food

taste good.

Box 8: Saint Vincent and the Grenadines behavioral trial example


Step 5 45

behaviour trials pertaining to respondents’ thoughts, knowledge, beliefs andperceptions regarding food and dietary practices were tallied and analysed.

Second, the teams were divided into groups. Each group was given onerecommendation to analyse. In order to interpret the information, the groupsexamined and tallied what the informants actually said, taking into account theirfeelings and beliefs and the veracity of their intentions. The interpretation of theinformation was as simple and direct as possible. Although it was time consuming,the groups tried to focus on issues that were mentioned frequently or that wereoutstanding, they tried to discover the relationships between the different aspectsand look for similarities and differences based on the objectives of the research.Also they were asked to find any relationship among the differentrecommendations.

For each of the recommendations, the group reviewed the actual behaviours,obstacles, and messages that were sent to the target population who participated inthe trial and the following aspects were analysed:

1. Were the messages understood by them?

2. Did respondents recognize the six food groups that were being promoted?

3. Were respondents able to follow the recommendations or follow them to someextent?

4. For how many days were they able to follow the recommendations?

5. What changes did they make to the recommendations?

6. Reasons for following or not following the recommendations.

7. Suggestions from respondents about informing other people of therecommendations.

The recommendations were then based on the results. These reflected the needs andperceptions of the participants in the behaviour trial and specified the actions thatshould be adopted.

5

“It's not hard and I can do without using the oil and butter, the food does not taste

any different.”

“It is healthier.”

“To make me live longer and stop me from getting bad heart.”

“Because of my weight I know I must cut down on lots of fats and oil I do less frying

and stewing and since you encourage me.”



In order to facilitate the development of conclusions for each statement, theproblem, the objective, and the variables that were causing the problems werereviewed.

FBDGs graphic design

The graphic representation of the FBDGs serves a number of important functions.It allows easy identification and is usually in the shape of an important culturalsymbol. Pictures or a diagram are used to help the target group easily recall whatfood it should include in its diet at and in what proportions. Three major criteriamust be met by the graphic: cultural acceptability; proportionality; and variety. Thegraphic artist should be involved in the development of the FBDGs so that theyappreciate the concepts that are supposed to be conveyed.

Cultural acceptability

To meet this criterion the graphic must be selected by the target population. Task-force members, using their knowledge of the culture, suggest six to eight potentialgraphics which are then sketched by a local artist. The graphics are shown withoutthe food initially. Focus-group participants were then asked to select a graphicbased on two questions:

1. Which of these diagrams makes you think of your country?

2. If we were to show you how to divide the different types of food you should eatevery day, which of these diagrams would you like to see them on?

Based on the results of the participants’ ranking of the graphic, the first and secondchoices were then returned to the population with depictions of food added. Thiswas carried out during the field testing of the messages when respondents are askedto select the one that best answers the two questions above. Annex 3 present theinstruments for choosing the diagram in Saint Vincent and the Grenadines andGrenada.

Proportionality

The graphic should at a glance send a message of proportionality. This means thatit should indicate which food group should form the largest or smallest portion ofthe daily food intake. Based on the objectives (Step 3) and the technicalrecommendations and diet calculations (Step 4) a distribution of food could bedepicted as shown in Figure 5.

5


Step 5 47

5

Variety

To meet the criterion of variety, the graphic should indicate all food groupings.Each grouping must contain examples of foods that are easily available and arecommonly eaten by the population.

30%

15%

15%

20%

12%

6% 2%

S tap les

F ru it V eg etab les F o o d f r o mA n im alsL eg u m esF atS u g ar

Fig. 5 Proportionality



The purpose of this step is to prepare the FBDGs messages using the results of thebehavioural trials and to link the concept of variety of foods and portion sizes to the diagram.

An inter-country meeting was held between the four countries which focused onways to improve the recommendations, to review the results of the field testing oftechnical recommendations and to define the communication strategy and toolsneeded to implement the FBDGs. This step comprises:

• Review the results of the behavioural trials• Messages development

Review the results of the behavioural trials

Through the testing of the recommendations, the national teams found that theconsumers’ abilities to understand the recommendations varied and that messagesneeded to be revised to make them clearer and more useful.

The field work enabled the national teams to acquire information that was usefulfor developing realistic messages. The respondents gave information fordeveloping tips for following recommendations and used everyday language whichcould be incorporated into the messages so that the public would understand themessages and find them motivating.

The findings from the behavioural trials indicated that:

• Food costs and seasonal availability were major constraints which affected thehouseholds’ ability to follow recommendations. This was especially true in thecase of vegetables.

• Consumers were aware of the associations between salt and fat andcardiovascular diseases.

• Preparation time and taste were obstacles to following the recommendation totrim off the fat from meats prior to cooking.

• Consumers could reduce the salt used in home-made foods but could not controlthe salt in purchased foods.

• Eating a variety of foods was difficult because of the cost of foods and the timeneeded for preparation.

6

STEP 6: Finalizing the FBDGs


Step 6 49

• Eating more fruits and vegetables was too costly for many households. There wassome concern about alcohol consumption, especially consumption by young men.

Messages development

After the behavioural trials, the guidelines were prepared and the messages anddiagram were approved. The guidelines are the recommendations that thepopulation will receive through messages, which may be complemented by thediagram.

The recommendations from the guidelines are selected on the basis of two criteria:(i) the objectives of the guidelines and (ii) their potential for implementation by thetarget group. In order for the population to remember them and to facilitate theirdissemination through the media, the ideal number of messages in the nutritionguidelines is between six and eight.

The national teams developed their draft FDBG based on the results of their testingof the messages and the workshop discussions. All of the workshop participantsand resource persons reviewed each set of FBDGs and made suggestions to thenational teams. The four sets of draft recommendations are included in Table 11.

6

Table 11: Draft FBDGs Recommendations from Dominica, Grenada,Saint Lucia and Saint Vincent and the Grenadines

Dominica - Revised Recommendations

• Start the day with breakfast.

• Always try to eat a variety of foods

every day. Use the basket to help you

make the choices.

• Eat more vegetables and fruits every

day.

• Reduce fat and oil intake.

• Choose less sweet foods and drinks.

• Use less salt, salted foods, seasonings

and salty snacks.

• Make physical activity a part of your

daily life.

• Drink water several times a day.

• If you use alcohol, do so in moderation.

Grenada - Revised recommendations

• Choose to eat a variety of foods every

day

• Eat larger amounts of fruits and

coloured vegetables every day.

• Eat less fatty, oily, greasy and

barbequed foods.

• Use less salt, salty foods, seasonings and

snacks.

• Choose to have less sweet foods and

drinks.

• Make water your drink of choice several

times a day.

• Satisfy your thirst with water. Drink

more!

• If you drink alcohol, do so sparingly.

• Get moving! Be more physically active

everyday.



Following approval by the multi-sectoral committees in each country, the finalmessages were validated with focus group testing to ensure that they wereunderstood by the lay person.

In addition to drafting the messages, the workshop participants brainstormed abouttips for assisting people to follow the FBDGs. Some examples ofrecommendations and tips are listed in Box 9:

Table 11 (continued): Draft FBDGs Recommendations from Dominica,Grenada, Saint Lucia and Saint Vincent and the Grenadines

Dietary Guidelines for Saint Lucia -

Revised Recommendations

• Always try to include more ground

provisions, peas and beans in your

meals every day.

• Eat more vegetables and fruits daily.

• Buy less fatty and greasy foods and

when you cook use less fats and oils.

• Use less salt, salted foods, packaged

seasonings and salty snacks.

• Choose less sweet beverages and foods

preserved or prepared with added

sugar.

• If you drink alcohol, do so in

moderation.

• Drink water several times a day.

• Make exercise a part of your daily life.

Saint Vincent and the Grenadines -

Revised Recommendations

• Eat more vegetables and fruits every

day.

• Reduce fats and oils by cutting back on

fatty, oily and greasy foods.

• As frequently as possible, use steaming,

boiling, and baking instead of frying,

stewing and barbecuing.

• Reduce the intake of sugar:

• Choose to use less sugar, sweet foods

and drinks.

• When cooking use less salt and salted

seasonings. Eat less salted foods and

snacks.

• Water is a natural drink; choose to drink

it several times a day.

• If you drink alcohol, do so sparingly

6


Step 6 51

6

Messages of the FBDGs were refined using advice from communication experts.These are summarized in Box 11:

Recommendation Tips and messages

Drink water “Keep a glass of water on your desk everyday”; “Set

your mobile phone to announce another drink

water time”; “If you don't like plain water, drink

coconut water.”

Reduce fat intake “Use a teaspoon, not a pot spoon”; “Read labels,

choose salad dressing wisely”; “Fewer fats,

healthier hearts”; “Use less grease and take out skin

and fat”

Reduce salt “Use less salty seasonings”; “Use less salty snacks”;

“Use less salt when cooking and eat less salted

foods and products”

Drink alcohol sparingly “Make one drink last longer”; “Replace at least one

alcoholic drink with a non-alcoholic drink”; “Drink

by choice- not by chance”; “Less alcohol - more self

confidence and control”

Reduce sugar “Get sugar from natural sources, like fruits”; “Love

yourself more - choose to share all your sweets with

a friend”; “Take less sugar to have a sweet smile”

Box 9: Tips and motivational messages

• Give messages that help consumers use their common sense to improve their

lifestyle.

• Use positive, short and simple recommendations.

• Be specific and describe a specific action.

• Don't assume that the consumers know the benefits. Tell them.

• Make it easy: divide the process in easy and short steps.

• Offer concrete and measurable results. Don't make false promises.

• Include many examples according to the audience habits.

• Use sense of humour when it is possible and appropriate.

• Incorporate recommendations that save time.

Box 10: Advice for writing messages



7

The purpose of this step is to link the messages with the diagram and to field testthe FBDGs messages and diagram.

The guidelines should be field tested on people representative of the targetpopulation to determine whether or not the message or picture are understood,relevant, acceptable and persuasive. The guidelines may be theoretically correct,but if they are not understood, remembered and applied by the people for whomthey are intended, they will not achieve their purpose. It is suggested that thetesting be conducted in three phases: (i) the message alone, (ii) the diagram and (iii)the two together in the testing stage.

In Step 5, the national team pre-tested concepts and drawings of graphics to ensurethat that they were culturally appropriate. The options for each country were variedfrom commonly available foods, such as breadfruit to the national bird totraditional baskets to women in traditional dress. The multi-sectoral committeesmade the final decision about the graphic.

In Step 6, the national team developed their draft FBDGs messages /recommendations (Table 11) based on the result of the behavioural trials. Themulti-sectoral committees made the final decision about the messages. The finalmessages were validated with focus groups to ensure that they were understood bythe lay person.

After the food groups were added to the graphic, the mock-ups were tested withfocus groups in each country to ensure that the meaning was understood.

STEP 7: Validating the FBDGs


Step 8 53

The purpose of this step is to prepare the final version of the FBDGs. Correctionand adjustments were made to messages and diagram based on the test result andan additional technical review by the multi-sectoral committees. A graphic artistprepared the last version of the diagram.

8

STEP 8: Correcting and adjusting the FBDGs

The final guidelines and pictorial diagram are aproved by the committee.



The purpose of this step is to reproduce, disseminate and implement the FBDGs anationally through the public and private sector, using a sound communicationstrategy. This step comprises:

• Approval of the FBDGs by government.

• Development of the communication strategy

• Development of the educational material

• Planning the official national launch

Approval of the FBDGs and food diagram

The draft guidelines were submitted for approval by the relevant government bodyin each country so that they could become the official FBDGs and food diagram ofthe respective national governments. In some countries this process took more thanthree months.

Development of the communication strategy

Once the FBDGs have been developed and approved by the government, a strategyand funds are needed to disseminate the guidelines to reach the target populationgroups. The most common methods for disseminating the guidelines focus onproviding materials and training through the health and education systems. Forinstance, school teachers may incorporate FBDGs into their class curricula andnurses and home economists can make use of them during counseling sessions.FBDGs can be distributed to workplaces, food markets, restaurants and food outlets.They can also be promoted at agricultural fairs, sports events and festivals.

FBDGs are also widely distributed to the target population as brochures, posters orradio or television messages. It is best to provide related educational materials andprogrammes to elaborate and explain the guidelines so as to in turn support theFBDGs. Further, messages should be reinforced by using a number of channels ofcommunication. Regional and national mass media campaigns when used shouldensure a coordinated and consistent dissemination of the messages.

Common obstacles to promoting FBDGs are the lack of expertise incommunication strategies and lack of resources for producing materials. Some

9

STEP 9: Implementing the FBDGs


Step 9 55

countries have procedures for obtaining and approving sponsorship of materialsand activities from the private sector. This allows for the promotion of nutritionmessages and food guides on food packages or through other commercial channels.

Communication strategies

Experiences in other regions show that FBDGs are not always promoted effectivelyand that a strategy for communication, as well as resources, is needed.

The teams identified their main goals within the communication strategies (e.g.slogan competition, production and airing of jingles on radio and television); theyelaborated the objectives, indicators, messages, priorities, audiences (primary andsecondary), channels, lead agencies, timeframes and budget for each goal. Thedraft communication strategy from Saint Vincent and the Grenadines is providedas an example in Annex 6.

For each country, the communication strategy included as a minimum thepublication of a poster and a booklet to be disseminated widely. Other activitiessuch as parades, theatre, promotions in grocery stores, and messages on products,radio programmes and training in schools were included in the plans.

The countries identified short-term and long-term activities for promoting theFBDGs. It was agreed that the countries would produce their first sets of materials(flyer, poster, radio spot and booklets) through the project budget to be available at thetime of the launch of the FBDGs. In the long term, other methods were identified forsustained promotion such as billboards, television, packages and promotions inmarkets. The national coordinators and communication specialists identify potentialpartners to support these more costly campaigns. It was noted that social organizationsand private sector partners may be able to assist in promoting the FBDGs.

Long-term communication strategy

Planning a long-term communication strategy frequently requires advice fromcommunication experts. This step usually requires substantial amounts of money –sponsoring events, designing educational materials, printing information andbroadcasting messages can be costly. Working with communication specialists andfinding the funds to produce information are two of the most challenging aspectsof implementing FBDGs. At this stage, the multi-sectoral committee needs to bemobilized to provide contacts, ideas and resources for promoting the FBDGs.

This phase of implementation of FBDGs was considered so vital to the successfulimplementation of FBDGs that FAO held an inter-country workshop to focusspecifically on how to develop a communication strategy. In every country, there

9



was a range of ways that the FBDGs messages and food guides could bedisseminated. Box 11 indicates where the FBDGs can be implemented and Box 12offers ideas of media that can be used to promote the FBDGs.

Educational material design

Once each country has the messages and graphic design tested and refined,educational material should be developed. For the purposes of developing FBDGs,three kinds of educational material were proposed:

1) Poster.

2) Brochure.

3) Booklet.

An outline for the booklet was prepared and explained to the group, which ispresented in Box 13.

9

• Health centres and health workers.• Schools, teachers and food services • Workplace canteens/cafeterias, employers and employees.• Social Welfare Organizations/Services and social workers.• Sports facilities and events/coaches/athletes. • Food markets.• Restaurants and food outlets.• Meetings of professional societies (e.g. medical associations) and authoritative

speakers/endorsements.• Special events - e.g. Nutrition Week, Agricultural Fairs and exhibitions, holidays,

parades.• Extension agents/community workers.• Religious centres and religious leaders.• Non-governmental organizations.

Box 11: Places and events where FBDGs can be disseminated

• Radio.

• Television.

• Billboards/posters.

Box 12: Media for disseminating FBDGs

• Newspapers/magazines.

• Websites.

• Product packages and commercial spaces.


Step 9 57

Official national launch of the FBDGs

To achieve the desired behavioural change, FBDGs should be communicated to thepublic through a variety of materials, programmes, settings and media. Officialnational launches were used in countries as the first step in communicating theFBDGs to the general public. Each national team prepared their plans for the launch.

The first public announcement or launch of the FBDGs is considered to be essentialto the implementation process. Launches are complex events involvingceremonies, entertaining jingles, influential persons, distribution of materials andmedia coverage. Since they require careful planning and expenditures, theworkshop participants devoted considerable time to discussing the launches.

The activity of planning and organizing the launch is usually undertaken by thenational task force under the direction of the permanent secretary of the host ministry(health or agriculture). The venues selected tended to be places of prominence in thecountry with large holding capacity such as a memorial hall, a trade centre or anational park. Several strategies have been used to sensitize and attract the public tothe event, including using a “Town Crier” on the day of the event; press briefing priorto the launch and a radio panel discussion on FBDGs. In all in the project countries,banners announcing the event were mounted at strategic locations throughout thecountry. In addition, educational institutions and organizations represented on themultisectorial committee were sent special letters of invitation.

9

I. Description of the processA. Institutions that participated in the multi-sectoral group.B. Explanation of why the FBDGs were developed.C. Description of how the FBDGs were developed and by whom.

II. Explanation of the body's need for food and nutrientsA. Carbohydrates, fats and proteins.B. Vitamins and minerals.

III. Individual messages in the FBDGs A. Food included in the message.B. Characteristics of the foods.C. Advice and tips for changing behaviour.D. Advice and tips for overcoming barriers to change in diet.E. Benefits of the recommendation.

IV. Self-AssessmentV. Portion sizes (with examples from a range of diets).VI. Healthy recipes.VII. Glossary of terms used in the booklet.

Box 13: Outlines for booklets



The format of the launching ceremony varied in each country but generallyfeatured the following:

• Presentations. Speeches delivered by prominent national and internationalofficials such as ministers of health and/or agriculture, FAO regionalrepresentatives and director/representative of CFNI.

• Feature address and official launch of the guidelines. This was usually doneby the minister of health or agriculture.

• Unveiling of the guidelines. This was carried out by the governor general orpresident.

• Cultural items. These were usually done by school children or local artists anduse message from the FBDGs as the content of their presentations in songs,poems, dance or drama. Musical presentations by local cultural groups also tookplace.

• Dissemination of promotional materials. The official launch was used as achannel for disseminating materials developed for promoting the FBDGs.Materials included FBDGs graphic, posters, brochures, flyers, shopping bags andother promotional items. Box 17 suggests some other activities to support thenational launch.

9 Radio discussions.

Motorcade from launch to exhibition.

Food exhibition highlighting each

FBDGs.

Development of a video.

Composition of a song.

TV panel discussion.

Radio interactive show.

Radio slots during the week.

Radio talk shows.

Radio quiz.

Billboards.

Banners.

Physical activity in open spaces.

Jingle.

Development of promotional materials

(pens, bags).

Newspaper pull-out/inserts.

Mass dissemination (schools).

Poster exhibition.

Mascot demonstration.

Box 14: Suggested activities in support of the national launch


Poster 59


Poster 61


Step 10 63

10

The FBDGs should be periodically evaluated in terms of both the implementationprocess and their impact on the lifestyle of target group. Campaigns andeducational programmes for promotion and adoption of FBDGs should bemonitored and evaluated to determine their reach, frequency and impact. However,relatively few countries have evaluated the impact of FBDGs – either becauseguidelines were developed only recently, it is too early to evaluate their effects, orbecause there are insufficient resources and methodologies for evaluation.

STEP 10: Evaluation of FBDGs


65

Lessons learned in the project

At the end of the project, the national coordinators, consultants and FAO staff metto review the experiences and lessons learned during the project. In addition to theinformation shared in the manual, the project gained the following insights.

PoliticalA key institution and support from a senior government official is needed to pushthe process forward. FBDGs need to be viewed as part of the national policy to getpolitical support.Meetings to sensitize different actors are important. These meetings could beconducted by universities or prestigious institutions.Some topics are sensitive and affect stakeholder groups. For example, sugarconsumption is a political issue in the Caribbean.

OrganizationalThere can be obstacles to participation of the task force or multi-sectoral committeemembers. Some members may be too busy. Sometimes the high-level members donot attend all the meetings.The task force members should report to the permanentsecretary of the ministry which is leading the process. The process of producing FBDGs took around two years in the project (this istypical for most countries). The schedule should be adhered to; otherwise, the taskforce members lose interest if the process takes longer than planned. The participation by NGOs and the private sector cannot be taken for granted;many did not participate.The launch should be planned as a whole-week activity, including a week before raisingawareness through the media. National committees need to invite very senior people andagencies to the launch at least one month before and remind them the activity.The National Coordinator should carry out advocacy with the government during

Afterword



the process. After all the development work is done, the Cabinet approval ofFBDGs usually took one month. However, when there were changes ingovernment, the process was affected. Political parties and stakeholder groupsshould not view the FBDGs as belonging to one group; when the process isfollowed, the FBDGs are “made by the country not by an official group”. They arebased on the population’s needs and perspectives.

ResourcesProduction of educational materials and field work are costly. Project plannersshould attempt to accurately plan the details of budgets. For example, the quantitiesof posters to distribute can be high.Training teachers, health workers, agriculture personnel, and others in how to useand explain FBDGs to their target population has to be planned. To train differentpersonnel, the regular meetings should be used. For example, teachers and nursescan be trained to use FBDGs during their routine in-service training meetings.FDBG can be incorporated into training curricula. Working with graphic designers takes time. Some designers had difficultyunderstanding the technical meaning of the graphic and the concept ofproportionality. In small countries, the choice of designers and printers may belimited. The process requires significant amounts of staff time. The ministry which leadsthe FBDGs process needs to allocate staff for this.


67

CFNI (Caribbean Food and Nutrition Institute). 2001. Obesity prevention andcontrol – the Caribbean experience, April. Kingston.

FAO. 1996. “Rome Declaration on World Food Security” World Food Summit13-17 November 1996, Rome.(www.fao.org/DOCREP/003/W3613E/W3613E00.htm).

FAO and WHO. 1992. International Conference on Nutrition World Declarationand Plan of Action for Nutrition. December. Rome.

FAO/WHO. 1992. World Declaration on Nutrition and Plan of Action, Food,Nutrition and Agriculture, 5/6: 27–49.

FAO. 1996. Rome Declaration on World Food Security. World Food Summit 13-17 November. Rome. (www.fao.org/docrep/003/w3613e/w3613e00.htm)

Friesinger,G.C.and Ryan, T.J. 1999. Coronary heart disease, stable and unstableconditions. Cardiology Clinics, 17:93-122.

Grim, CE et al. 1994 The Dominica Twin Study: Blood Pressure but not HbA1cis under genetic control in blacks in Dominica. Presented to the AHA 67th

Scientific Sessions. Circulation, 90: 1-503.

Henry, F., Morris, A. & Anderson, S. 2001. Food and nutrition. HealthConditions in the Caribbean. Pan American Health Organization (PAHO),Washington, D.C. 190–203.

Henry, F.J. 2001. Obesity-related mortality, morbidity and behaviour in theCaribbean. Cajanus, 34: 62–72.

Henry, F.J. 2004. The obesity epidemic – a major threat to Caribbeandevelopment: The case for public policies. Cajanus, 37(1): 3–21.

References



Hill, J.O.,Wyatt,H.R.and Melanson, E.L. 2000. Genetic and environmentalcontributions to obesity. Medical Clinics of North America, 84(2): 333–46.

Molina V. et. al. April 1995. Lineamientos generales para la elaboracion de guiasalimentarias. Una propuesta de INCAP, Guatemala.

Molina, V. et. al. 2001. Documento técnico guias alimentarias para Guatemala.Comision Nacional de Guias Alimentarias, Guatemala.

PAHO (Pan American Health Organization). 2002. Health in the Americas,Volume II. Scientific and Technical Publication, 587, PAHO, Washington,DC.

Peña, M. & Molina, V. 1999. Food based dietary guidelines and healthpromotion in Latin America. PAHO and Institute of Nutrition of CentralAmerica and Panama, Washington DC.

Reddy, S.K, 1998. Cardiovascular disease in the developing countries.Heartbeat, 2: 4-6.

Riopel, D.A., et al. 1986. Coronary risk factor modification in children: exercise.A Statement for Physicians by the Committee on Atherosclerosis andHypertension in Childhood of the Council on Cardiovascular Disease in theYoung, American Heart Association. Circulation, 74: 1189A–91A.

Sinha, D.P. 1995. Changing patterns of food, nutrition and health in the Caribbean.Nutrition Research, 15: 899–938.

UN (United Nations) 2006. The Millennium Development Goals Report 2006New York http://www.un.org/millenniumgoals/goals.html#

WHO. 1996. Preparation and use of food-based dietary guidelines. Report ofJoint FAO/WHO Consultation, Geneva, 1996.

WHO. 2001. Diet, physical activity and Health. WHO, Geneva. (Doc #A55/16)http://www.who.int/dietphysicalactivity/strategy/eb11344/en/


69

Annex 1 Testing Recommendations for Feasibility

example from Dominica

Focus Group Guide: Recommendation No. 1 Read the following:

1. Reduce fat and oil intake.

1. What do you understand from the statement?2. What are the foods you prepare using fats?

PROBE solid and oils?3. Do you trim off the fat? (Meat /poultry)

a) When? (Before or after cooking) PROBE Why?4. What do you do with the fat that you trim off meat?5. What foods do you add fat to before eating?

a) Which fats?b) To which foods?

6. Do you make gravy? How do you make it?7. What are the foods that you eat fried?8. What type of fats or oil do you use for frying?9. Could you prepare these foods any other way?

a) How?10. Do you use salad dressings?

a) (If yes) what types? b) What foods do you use them on?

11. What types of packaged seasonings do you use?12. What foods do you consider as fast foods? PROBE13. How often do you and your family eat these foods?14. Which are the fast foods you eat more often and why?15. Do you understand the food labels?16. Name the six food groups.



Annex 2 Behavioural trial

Initial Interview: Recommendation

Read the following:

Reduce fat and oil intake.

Name ____________________________________________________________

Address______________________________________Phone________________

Age________Education level______________________Sex_________________

No. of persons in the house _______Adults ______Children <5_____ >5 _______

Interviewer _____________________________Date of Interview _____________

1. What are some of the things you prepare using fats and oils?

__________________________________________________________________

__________________________________________________________________

2. Do you trim off the fat? (Meat and poultry) _____________________________

__________________________________________________________________

When? (Before or after cooking)________________________________________

3. What do you do with the fats? ________________________________________

__________________________________________________________________

4. Are there any foods that you add fat to before eating? _____________________


Annex 2 71

__________________________________________________________________

Which fats? ________________________________________________________

To which foods? ____________________________________________________

5. Do you make gravy? _______________________________________________

How do you make it?_________________________________________________

6. What are the foods that you eat fried?

__________________________________________________________________

Who eats these foods?________________________________________________

7. What type of fats or oil do you use for frying? ___________________________

__________________________________________________________________

8. Could you prepare these foods any other way?___________________________

How? ____________________________________________________________

9. Do you use salad dressings?_________________________________________

(If yes) what types? __________________________________________________

What foods do you use them on?______________________________________

Who eats these foods?________________________________________________

10. What types of seasonings do you use?_________________________________

__________________________________________________________________

11. What foods do you consider as fast foods? _____________________________

__________________________________________________________________

12. How often do you and your family eat these foods? ______________________

__________________________________________________________________

13. Which are the ones you eat more often and why? _______________________



Final Interview: Recommendation (Reduce fat and oil intake)

Name_____________________________________________________________

Address______________________________________Phone________________

District____________________________________________________________

Interviewer _________________________ Date of interview ________________

1. Do you remember what we spoke about last time? (ASK THEM TO EXPLAIN)

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

2. Were you able to follow the recommendation? Yes______ No______

Somewhat________ (YES) Why? ____________________________________

__________________________________________________________________

(NO or somewhat) Why? _____________________________________________

__________________________________________________________________

3. Did you have any problem following the recommendation? Yes_____ No_____

(YES) What exactly?_________________________________________________

__________________________________________________________________

__________________________________________________________________

4. For how many days did you follow this recommendation?__________________

__________________________________________________________________

5. Did you make any changes? YES _____ NO ______ (YES) What?

__________________________________________________________________

__________________________________________________________________


Annex 2 73

6. Do you plan to continue with the recommendation in the future? YES________

NO______ If YES, why?______________________________________________

If NO, why not?_____________________________________________________

7. What would you suggest to other people so that they would reduce their fat

intake? _________________________________________________________

__________________________________________________________________



Annex 3 Choosing the pictorial diagram

Saint Vincent and the Grenadines

Instructions:

Each diagram should have a number on the bottom. Try to post all diagramson the wall. Ask the participants to look at them very carefully and askindividually the following questions:

1. Which of these diagrams makes you think more of our country?

2. Why?

3. If we were to show you how to divide the different types of foods you should eatevery day, which of these diagrams would you like to see them on?

4. Do you have any suggestions?


75Annex 3

Grenada

Instructions:

1. We are encouraging healthy lifestyle habits for our people and we want toillustrate it in picture form. On which of these diagrams would you like to seethose tips illustrated? (Select first and second choices)

2. Why?

Follow the sample below:

Choice Diagram #

1st

2nd

1st 2nd Reasons VillageChoice ChoiceBanana Nutmeg Banana – its food Harford

Isle of spice Village



An

nex

4D

raft

Co

mm

un

icat

ion

Str

ateg

y -

Sain

t V

ince

nt

and

th

e G

ren

adin

esM

ain

go

al

Ob

ject

ives

Ind

icato

rsD

raft

M

ess

ag

ePri

ori

ty l

evel

(An

cho

r A

ctiv

ity)

(Mil

est

on

e

Act

ivit

y)

Au

die

nce

s:

Pri

mary

Seco

nd

ary

Typ

e o

f A

ctiv

ity

an

d/o

r o

utp

ut

Ch

an

nels

Lead

Ag

en

cyPart

ner

Ag

en

cies

Tim

e F

ram

eB

ud

get

1st

qu

arte

r2n

d

qu

arte

r

3rd

qu

arte

r

4th

qu

arte

r

Mu

ltis

ect

ora

l/Ta

sk F

orc

e M

eeti

ng

To d

irec

t an

d

imp

lem

ent

the

FBD

G a

nd

mo

nit

or

and

eval

uat

e th

e

sam

e

Fou

r (4

)

qu

arte

rly

mee

tin

gs

of

Task

Fo

rce

Pro

visi

on

of

Qu

arte

rly

Rep

ort

s

An

cho

rM

inu

tes

of

mee

tin

gs

and

qu

arte

rly

revi

ews

Min

. of

Ag

ric.

and

Hea

lth

Oth

er G

ovt

Dep

ts,

NG

Os

and

Pri

vate

Sec

tor

Ap

ril

mee

tin

g

July

O

cto

ber

D

ec–J

an

Pro

du

ctio

n o

f B

oo

kle

tTo

dra

ft a

nd

pro

du

ce

tech

nic

al

bo

okl

et o

n

gu

idel

ines

Dra

ft

Fin

al

Bo

okl

et

pre

par

ed

Tech

nic

al

info

rmat

ion

rela

ted

to

th

e

FBD

G

Mile

sto

ne

Prim

ary:

Gen

eral

Pu

blic

Seco

nd

ary:

Tech

nic

al

Pers

on

nel

,

Nu

trit

ion

ist,

Do

cto

rs, N

urs

es

Teac

her

s et

c,

250

bo

okl

ets

Clin

ics,

Do

cto

rs

Offi

ces

Phar

mac

ies

Lib

rari

es

Sch

oo

ls,

Ch

urc

hes

etc

;

Mu

ltis

ecto

ral

Task

Fo

rce

CFN

I/FA

O

Nu

rses

Ass

oci

atio

n,

Med

ical

Ass

oci

atio

n

Co

mp

lete

d

by

2nd

mo

nth

in

Jan

uar

y

Slo

gan

Co

mp

eti

tio

nTo

pro

du

ce

pro

mo

tio

nal

item

to

sup

po

rt

cam

pai

gn

Mile

sto

ne

Prim

ary:

Gen

eral

Pu

blic

Slo

gan

on

pro

mo

tio

nal

item

s

Au

dio

-vis

ual

,

Rad

io a

nd

TV a

nd

Pri

nt

Mat

eria

ls

Min

istr

y

of

Hea

lth

,

Min

istr

y o

f

Ag

ricu

ltu

re

Min

istr

y o

f Ed

uca

tio

n

and

Cu

ltu

re

Pro

du

ctio

n a

nd

air

ing

of

Jin

gle

s –

Rad

io a

nd

TV

To p

rod

uce

pro

mo

tio

nal

item

s to

sup

po

rt

cam

pai

gn

an

d

secu

re t

he

sup

po

rt o

f

loca

l rad

io a

nd

TV s

tati

on

s fo

r

bro

adca

st o

f

sam

e

Jin

gle

s

pre

par

ed o

n

each

of

the

gu

idel

ines

Mile

sto

ne

Prim

ary:

Gen

eral

Pu

blic

Seco

nd

ary:

Med

ia H

ou

se

Man

ager

s an

d

Pers

on

nel

Nin

e (9

)

jing

les

pre

par

ed

All

Rad

io a

nd

Tele

visi

on

Stat

ion

s

Min

istr

y

of

Hea

lth

,

Min

istr

y o

f

Ag

ricu

ltu

re

API

, NB

C

All

oth

er R

adio

an

d

TV S

tati

on

s

Co

rpo

rate

Sec

tor

Jan

.–M

ar.


Annex 4 77Pro

du

ctio

n a

nd

Est

ab

lish

men

t o

f Tw

o B

illb

oard

s

To p

rep

are,

esta

blis

h a

nd

mai

nta

in

bill

bo

ard

s

at s

trat

egic

loca

tio

ns

dep

icti

ng

th

e

FBD

G

Bo

ard

s

wit

h m

ain

gra

ph

ic a

nd

gu

idel

ines

Mile

sto

ne

Prim

ary:

Gen

eral

Pop

ula

tio

n

Two

(2

)

bill

bo

ard

s

pre

par

ed a

nd

esta

blis

hed

at s

trat

egic

loca

tio

ns

Mu

ltis

ecto

ral

Task

Fo

rce

Cen

tral

Pla

nn

ing

Ch

amb

er o

f In

du

stry

and

Co

mm

erce

– C

orp

ora

te S

ecto

r

(EC

GC

)

Ap

r.–Ju

ne

July

– A

ug

.

Pu

bli

c-Sp

eakin

g

Co

mp

eti

tio

n

(Sch

oo

ls)

To u

se t

he

com

pet

itio

n

to f

urt

her

hig

hlig

ht

the

gu

idel

ines

Mile

sto

ne

Prim

ary:

Spec

ifi c

Au

die

nce

Seco

nd

ary:

Part

icip

ants

Teac

her

s

Live

tele

visi

on

and

rad

io

bro

adca

st o

f

the

even

t

Rad

io a

nd

tele

visi

on

Mu

ltis

ecto

ral

Task

Fo

rce

Cab

le a

nd

Wir

eles

s/

Jayc

ees

Oct

.–N

ov.

Yo

un

g L

ead

ers

Pro

gra

mm

eTo

use

th

e

ann

ual

eve

nt

to h

igh

ligh

t

the

issu

e o

f

the

nee

d f

or

the

gu

idel

ines

and

a h

ealt

hy

po

pu

lati

on

Pro

mo

tio

nal

mat

eria

ls o

f

you

ng

lead

ers

pro

gra

mm

e

wit

h t

he

mes

sag

es

Mile

sto

ne

Prim

ary:

Gen

eral

Pu

blic

Seco

nd

ary:

Sch

oo

ls

Part

icip

ants

Teac

her

s

Var

iou

s

pro

mo

tio

nal

item

s as

det

erm

ined

by

the

You

ng

Lead

ers

Var

iou

s

chan

nel

s as

det

erm

ined

by

the

You

ng

Lead

ers

Mu

ltis

ecto

ral

Task

Fo

rce

RB

TT

Seco

nd

ary

Sch

oo

ls

Jan

.–M

ar.

Ap

r. –

Jun

e Se

pt

– D

ec.

Lab

ell

ing

of

Pack

ag

es,

bag

s etc

. in

Su

perm

ark

ets

To la

bel

pac

kag

es,

bag

s et

c. t

hat

are

use

fo

r

pla

cin

g lo

cal

foo

d it

ems

– ve

get

able

s,

mea

t, f

ruit

s

etc.

– f

or

a

per

iod

of

two

(2)

year

s

FBD

G e

ith

er

ind

ivid

ual

ly

or

in a

com

bin

atio

n

Mile

sto

ne

Prim

ary:

Ho

use

wiv

es

Gen

eral

Pu

blic

Seco

nd

ary:

Sup

erm

arke

t,

Foo

d S

tore

s

and

Res

tau

ran

t

Ow

ner

s

Var

iou

s

pac

kag

es,

bag

s,

con

tain

ers

wit

h

gu

idel

ines

Sup

erm

arke

t,

Res

tau

ran

t

and

Fo

od

sto

res

pro

du

cts

Mu

ltis

ecto

ral

Task

Fo

rce

Ch

amb

er o

f In

du

stry

and

Co

mm

erce

– Su

per

mar

ket,

Res

tau

ran

t an

d F

oo

d

Pro

cess

ing

fac

ility

Man

ager

s,

No

v..

Dec

.

Ad

op

tio

n o

f a

Gu

ideli

ne b

y a

M

em

ber

of

the

Co

rpo

rate

Sect

or

To u

se a

pro

du

ct o

f a

mem

ber

(s)

of

the

corp

ora

te

sect

or

to

pro

mo

te

gu

idel

ine

FBD

GM

ilest

on

ePr

imar

y:

Gen

eral

Pu

blic

Seco

nd

ary:

Co

rpo

rate

Sect

or

For

exam

ple

,

bo

ttle

d w

ater

and

th

e n

eed

for

dri

nki

ng

mo

re w

ater

Pro

du

cts

to b

e

det

erm

ined

Mu

ltis

ecto

ral

Task

Fo

rce

– C

ham

ber

of

Ind

ust

ry a

nd

Co

mm

erce

Mo

un

tain

To

p W

ater

Bo

ttlin

g a

nd

Co

con

ut

Wat

er B

ott

ling

,

ECG

C, V

acu

um

Pack

ing

Pro

du

cts

Cas

sava

Pro

du

cts

Jan

. D

ec.



Pro

du

ctio

n o

f a

Cale

nd

ar

To p

rom

ote

a g

uid

elin

e

wit

h t

ips

each

mo

nth

FBD

GM

ilest

on

ePr

imar

y:

Gen

eral

Pu

blic

Seco

nd

ary:

Man

agem

ent

of

Ban

k o

r V

inle

c

Cal

end

ar

dep

icti

ng

gu

idel

ines

each

mo

nth

Cal

end

arM

ult

isec

tora

l

Task

Fo

rce

Vin

lec,

Ban

kA

pr.–

Jun

e Ju

l.–Se

pt

Dec

.

Flyers

in

N

ew

spap

ers

To p

rod

uce

glo

ssy,

colo

urf

ul,

on

e-

leaf

fl y

ers

wit

h

gra

ph

ics

and

mes

sag

es t

o

ach

ieve

hig

h

imp

act

in t

he

po

pu

lati

on

Nin

e (9

) FB

DG

and

gra

ph

ic

wit

h f

oo

d

gro

up

s

Mile

sto

ne

Prim

ary:

Gen

eral

Pu

blic

10,0

00 fl

ier

sN

ewsp

aper

sM

ult

isec

tora

l

Task

Fo

rce

New

spap

ers

New

s, S

earc

hlig

ht

or

Vin

cen

tian

Last

wee

k

Dec

. an

d

Web

Pag

e w

ith

B

asi

c G

uid

eli

nes

To p

rod

uce

,

esta

blis

h

a w

eb

pre

sen

ce w

ith

gu

idel

ines

an

d

bo

okl

et

Gra

ph

ic a

nd

FBD

G

Mile

sto

ne

Prim

ary:

Gen

eral

Pu

blic

Seco

nd

ary

Web

Sit

e

Man

ager

s

Web

Site

wit

h

Gu

idel

ines

Go

vern

men

t

Web

site

,

wit

h li

nks

to

the

rele

van

t

Min

istr

ies,

Intr

anet

Min

istr

y

of

Hea

lth

,

Edu

cati

on

an

d

Ag

ricu

ltu

re

Web

Un

it, M

inis

try

of

Tele

com

mu

nic

atio

ns,

Scie

nce

an

d

Tech

no

log

y an

d

Ind

ust

ry

Oct

. –N

ov.

Pre

para

tio

n o

f A

dvert

isin

g B

oard

sTo

pro

mo

te

FBD

G a

t m

ajo

r

pla

yin

g fi

eld

s

and

har

d

cou

rts

Gra

ph

ic w

ith

foo

d g

rou

ps

and

FB

DG

s

Mile

sto

ne

Prim

ary

Spo

rtsp

erso

ns

Gen

eral

Pu

blic

Seco

nd

ary

Spo

rts

Ass

oci

atio

ns

and

Org

anis

atio

ns

At

leas

t 3

adve

rtis

ing

bo

ard

s

Ad

vert

isin

g

Bo

ard

s

Mu

ltis

ecto

ral

Task

Fo

rce

Nat

ion

al S

po

rts

Co

un

cil a

nd

rele

van

t sp

ort

ing

org

anis

atio

ns

Jan

. D

ec.

Pre

sen

tati

on

s to

C

om

mu

nit

y G

rou

ps

To p

rom

ote

FBD

G t

hro

ug

h

com

mu

nit

y

gro

up

s,

clu

bs

and

org

anis

atio

ns

and

Ad

ult

Lite

racy

pro

gra

mm

e

FBD

G a

nd

foo

d g

rou

ps

in g

rap

hic

Mile

sto

ne

Prim

ary

Spec

ifi c

Gro

up

s –

Ad

ult

Pop

ula

tio

n

Seco

nd

ary

Civ

ic a

nd

Co

mm

un

ity

Org

anis

atio

ns,

Lead

ersh

ip a

nd

mem

ber

s

15

con

stit

uen

cy

mee

tin

gs

Co

mm

un

ity

Pres

enta

tio

ns

Min

istr

y o

f

Hea

lth

Co

mm

un

ity

Dev

elo

pm

ent,

Min

istr

y o

f

Edu

cati

on

, Ad

ult

Lite

racy

Cru

sad

e

Jan

. M

ar.

An

nex

4 (

con

tin

ued

)


Annex 4 79In

corp

ora

tio

n

into

th

e H

om

e

Eco

no

mic

s C

urr

icu

lum

an

d

Sch

oo

l Fe

ed

ing

Pro

gra

mm

e

To e

nsu

re

that

th

e

gu

idel

ines

are

inco

rpo

rate

d

into

th

e h

om

e

eco

no

mic

s,

soci

al s

tud

ies

and

fam

ily

life

edu

cati

on

curr

icu

lum

and

th

e sc

ho

ol

feed

ing

pro

gra

mm

e

Foo

d g

rou

ps

and

FB

DG

Mile

sto

ne

Prim

ary

Sch

oo

l

Pop

ula

tio

n

Seco

nd

ary

Min

istr

y o

f

Edu

cati

on

Offi

cia

ls a

nd

Cu

rric

ulu

m

Dev

elo

pm

ent

Un

it,

Man

agem

ent

of

the

Sch

oo

l

Feed

ing

Pro

gra

mm

e

Gu

idel

ines

ado

pte

d in

all

sch

oo

ls in

th

e

pro

gra

mm

es

iden

tifi

ed

Cu

rric

ulu

m

and

Sch

oo

l

Feed

ing

pro

gra

mm

e

gu

idel

ines

Min

istr

y o

f

Edu

cati

on

Min

istr

y o

f H

ealt

hSe

pt

Pro

mo

tio

n f

or

Incr

ease

d V

eg

eta

ble

Pro

du

ctio

n

To e

nsu

re

that

op

tim

um

qu

anti

ties

of

veg

etab

les

are

avai

lab

le t

hat

are

of

go

od

qu

alit

y an

d

an a

ffo

rdab

le

pri

ce f

or

the

gen

eral

po

pu

lati

on

FBD

G

–Eat

mo

re

veg

etab

les

and

fru

its,

enco

ura

ge

farm

ers

to

pro

du

ce m

ore

veg

etab

les

Mile

sto

ne

Prim

ary

Farm

ers

Seco

nd

ary

Min

istr

y o

f

Ag

ricu

ltu

re

Exte

nsi

on

Sta

ff

and

Po

licy

Mak

ers

Veg

etab

le

Pro

du

ctio

n

Plan

Exte

nsi

on

Serv

ice

Farm

ers

mee

tin

gs

Rad

io a

nd

Tele

visi

on

Pro

gra

ms

Min

istr

y o

f

Ag

ricu

ltu

re

Min

istr

y o

f H

ealt

h

Sup

erm

arke

ts e

tc;

Sep

t

Mo

nit

ori

ng

an

d

Evalu

ati

on

of

the

Imp

lem

en

tati

on

of

the S

trate

gy a

nd

its

Im

pact

To c

on

du

ct

fou

r (4

)

sam

ple

surv

eys

ever

y

six

mo

nth

s

to a

sses

s th

e

imp

act

of

the

cam

pai

gn

Mu

ltis

ecto

ral

Task

Fo

rce

Jan

. –Ja

n.

Jul.

–Ju

l.


Developing Food-based

DietaryGuidelines

A manual from the English-speaking

Caribbean

Food-based dietary guidelines (FBDGs) provide practical advice

about ways to improve diets and health in a manner that is easy

for the public to understand. This manual explains a 10-step

process for developing FBDGs that can be used in most countries.

By following this process, nutritionists and others can create

FBDGs that are well-adapted to national needs and based on

nutrition science and communication expertise. A

multidisciplinary approach enables governments to assess the

country’s nutrition problems and to set realistic priorities for

improving diets. Technical recommendations are transformed into

simple messages the average person can follow. Nutritionists

learn to develop strategies for communicating dietary

information to the public. This manual is based on the

experiences of four Caribbean countries in developing national

FBDGs to promote healthy diets and to prevent obesity, diabetes

and cardiovascular diseases.

caribbean copertina ok 20-12-2007 6:41 Pagina 1

developing food-based dietary guidelinesdeveloping food-based dietary guidelines a manual from the...

Documents